Division of Consumer Services Mail or Fax Complaint Form

STATE OF WASHINGTON
DEPARTMENT OF FINANCIAL INSTITUTIONS
Division of Consumer Services
PO Box 41200
Olympia, Washington 98504-1200
Telephone (360) 902-8703
TDD (360) 664-8126
FAX (360) 664-2258

COMPLAINT FORM (Mail or Fax)

(Please read instructions before beginning.)

Against whom are you complaining?

Company name		Company contact (if any)

Street or mailing address		Telephone #

City		State		Zip Code

 

Your contact information:

Name		Telephone # (day)

Street or mailing address		Telephone # (evening)

City		State		Zip Code

Email Address (Optional)

What type of transaction did you conduct with the party named above (e.g. loan, closing, etc.)?

 

If the complaint involves a mortgage, what is the address of the property?
Street
City	State	Zip

Is this your primary residence?	Yes	No

 

When did the transaction occur? (if multiple dates, provide first date and clarify additional dates under description section)

 

Provide a concise description of the problem. (Remember to include who, what, when, where, why and how events transpired – see instructions.  Also, remember to attach/send copies of all documents relevant to the complaint.)

 

OPTIONAL SECTION: What do you think will resolve this problem for you? (be as specific as possible – see instructions)

 

Do you have an attorney? Yes No
Do you want us to work directly with your attorney?  Yes No
Attorney’s Name:

Firm:
Address:
Phone:
Your Signature		Date
Print Name Here:
Additional complaintant's		Date
Print Name Here:

 

Please print and fill in this form, then attach extra pages or material as needed and mail the completed form and attachments to:

Department of Financial Institutions Division of Consumer Services Attention: Complaints PO BOX 41200 Olympia, WA 98504

You may also Fax your complaint to us at 1-360-704-6984.