Washington State Department of Financial Institutions

Consumer Services Online Complaint Form

Before you begin, please review instructions on how to file a complaint with the Division of Consumer Services.

To file a complaint, please provide:

* Denotes a required field

Public Disclosure

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 by checking this box. 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

* Name
* Mailing Address
Address Continued
* City
* State
* Zip Code
* Phone Number
Fax Number
Email Address

Your Complaint is Against the Following Company:

* Company Name
Address
Address Continued
* City
Telephone
* State
Zip Code
Who You Contacted
 
* What type of transaction did you conduct with the
party named above (e.g. loan, closing, etc.)?
 
* When did the transaction occur?
(if multiple dates, provide first date and clarify
additional dates under complaint/problem section)

Complaint/Problem

* Provide a concise description of the problem

(Remember to include: who, what, when, where, why and how the events transpired - see instructions. Also remember to send copies of all documents relevant to the complaint.)

What do you think will resolve this problem for you?
(Be as specific as possible. See instructions.)

Mortgage Information

If your complaint involves a mortgage, what is the address of the property?

Address
Address Continued
City
State
Zip
Is this your primary residence? Yes   No

Attorney Information

Please check the following if they apply

I have an attorney
I would like you to work directly with my attorney
Attorney's Name
Firm
Address
City
State
Zip
Phone

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.

* Name:
* Date:

DFI