Financial Institutions Complaint Form. This is a Virginia form and can be use in Miscellaneous Secretary Of State.
Tags: Financial Institutions Complaint, Virginia Secretary Of State, Miscellaneous
COMPLETING THE COMPLAINT FORM PLEASE READ CAREFULLY. We are best able to assist you with your complaint if you do the following: 1. Answer all questions in their entirety, giving full name, titles, addresses and phone numbers. A summary of the facts surrounding the complaint and a statement of the desired resolution is necessary. Your signature is required for the Bureau to process your complaint. 2. Attach copies of any letters, documents, contracts or receipts pertinent to your complaint. (PLEASE DO NOT SEND ORIGINALS). Mail or fax your complaint to the address indicated on the complaint form. 3. Because of the complexity of some complaints, delays in processing do occur. We will make every effort to respond expeditiously to your complaint. 4. This office will thoroughly investigate your complaint if it is within our jurisdiction and make every effort to bring about a satisfactory resolution. American LegalNet, Inc. www.USCourtForms.com Virginia Bureau of Financial Institutions 1300 East Main Street, Suite 800 Post Office Box 640 Richmond, VA 23218-0640 (804) 371-9657 (804) 371-9416 (Fax) www.scc.virginia.gov FOR OFFICE USE ONLY: Complaint No. Date Received Name of Analyst Date Withdrawn Has this complaint been referred to the attention of: Attorney General Other Date Resolved 1. Read the Instructions for Filing a Consumer Type of Institution: Complaint before filling out this form. 2. PRINT OR TYPE all information in INK only. Bank Credit Union Return the completed form to the Bureau of Mortgage Company Other _____________________ Financial Institutions at the address shown above. Keep a copy for your records. Our authority is limited to those companies or institutions that are chartered, licensed, or supervised by the Bureau of Financial Institutions. Name of Company Today’s Date Company Address City, State, Zip Code Name of person(s) you dealt with Telephone No. ( ) Daytime Telephone No. ( ) - Your Full Name Your Address City, State, Zip Code Is your complaint currently the subject of pending Have you consulted legal litigation? Yes No counsel? Yes No Type of complaint: Checking/Draft Account Credit Card Trust Account Mortgage Loan Interest Rate Other Details of complaint (use continuation sheet if additional space is needed) Account/Loan No. Consumer Loan I authorize the Bureau of Financial Institutions to send a copy of this complaint, together with supporting documents, to the company against which the complaint is filed. Your signature is required for the Bureau to process your complaint. Signature of complainant Date signed Print or type name American LegalNet, Inc. www.USCourtForms.com