Securities and Investment Complaint Form

The Washington Public Records Act (PRA), RCW 42.56, may require disclosure of a complaint after a file is closed. If you choose, you may keep your identifying information exempt from disclosure under the PRA. Please note that this exemption does not necessarily restrict the release of your identifying information pursuant to a court order, subpoena, or during litigation.

Your Information

Your Complaint is Against the Following Business

Names, addresses, phone numbers of any other businesses, or persons involved in your complaint.

Additional Information

Explain Your Complaint in Detail

Please provide a detailed explanation of the facts that led to your complaint. Start at the beginning and continue through to the present. Be sure to include AT LEAST the following information: How, when, and from whom did you first hear about this investment? What oral or written information did you receive about the investment? Did you later find that any of this information was untrue?

Do you know anyone else who purchased the investment that is the subject of this complaint? If so, please list their names, addresses, phone numbers.

Jurisdiction of the Securities Division

The jurisdiction of the Securities Division generally extends only to issues connected with the initial offer and sale of securities, franchises, business opportunities, and commodities. We may not have jurisdiction if your complaint involves later actions by management that you think are unfair to investors, or in actions by management such as the failure to hold shareholder meetings or provide annual reports. However, you may have civil remedies available to address your complaint, so please consult your attorney. Also, the Division does not have the authority to represent you in civil litigation, which means you must hire your own attorney to recover your investment funds.

Declaration

By filling in my name and the date below, I declare, under penalty of perjury under the laws of the State of Washington that the information contained in this complaint is true and accurate and the information may be used to further investigate the complaint.

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