Escrow Online Complaint Form

Your Information

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

Property Address in Question (if different from mailing address)

Your Complaint is Against the Following Escrow Company:

*	Company Name
	Address
	Address Continued
*	City
*	State
	Zip Code
	Telephone
	Who You Contacted

Escrow Information

	Escrow Number
	Amount Funded
	Lender
	Date Escrow Opened

Purpose of Escrow (i.e., home purchase, refinance, commercial real estate, other, etc.)

Common Problems and Issues

Check all that apply

	Closing Delay
	Disbursement Problems
	Escrow Instructions Not Followed
	Title Transfers Incorrect or Incomplete
	Other

Your Complaint

* Please describe, in detail, the problem that you are having. Remember to include who, what, where, when, why and how the events transpired.

Disclosure of Complaint

Please be advised that in order to process your complaint, the Division of Consumer Services may send a copy of your complaint to the Escrow Agent or subject of your complaint. In addition, your complaint is a "public record" that could be subject to disclosure under a public records disclosure request. Therefore, your complaint may be seen by other people.

Public Records Disclosure Act

Under the public records provisions of Washington law, RCW 42.56 et.seq., this complaint may become subject to public disclosure at some time after your file is closed.

By checking this box, you may request that this complaint not be disclosed if it is requested pursuant to the Public Records Disclosure Act.

Declaration

By filling in my name and the date below, I declare that the information contained in this complaint is true and accurate and the information may be used to further investigate the complaint.

*	Name:
*	Date: