Important Notice: Disclosure of this information is voluntary. However, failure to supply complete information may result in this complaint not being processed.

Is your complaint against an institution we regulate ? The Division does not regulate banks, credit card companies or credit unions that have "Federal" in its name.

"It is important to remember that the Division does not act as the complainant's attorney. It also does not have the power to adjudicate complaints. If a dispute turns on facts that do not involve a supervised entity's violation of a specific law or regulation (such as a matter concerning a financial institution’s exercise of internal policies or guidelines) the Division may not have the authority to obtain the relief a complainant is seeking. In that case, the Department will advise the complainant about other ways to pursue the complaint, such as through consulting a private attorney and/or initiating a court proceeding."

Name of Company
Mailing Address:
City:
State:	State Alabama Alaska Arizona Arkansas British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Ontario Oregon Pennsylvania Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:
Telephone:	- -
Type of Company	Consumer Credit Credit Union Currency Exchange Licensee Money Transmitter
Date of Incident

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How do we contact you?

First Name:
Last Name:
Mailing Address 1:
Mailing Address 2:
City:
State:	State Alabama Alaska Arizona Arkansas British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Ontario Oregon Pennsylvania Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:
Day Phone:	- -
Evening Phone:	- -
Your E-mail Address:
Account Number

Briefly describe your complaint:

Please list the specifics of your complaint including dates of contact(s) individuals that assisted you and the actions you have taken to resolve this complaint. If more information is needed, you will be contacted by e-mail or telephone.

If you are unable to transmit this complaint, please print and mail to the Department.

Division of Financial Institutions
Currency Exchange Section
122 S. Michigan Ave, 19th Floor Chicago, IL 60603