STATE OF TENNESSEE DEPARTMENT OF FINANCIAL INSTITUTIONS CONSUMER RESOURCES DIVISION 414 UNION STREET, SUITE 1000 NASHVILLE, TENNESSEE 37219 Phone: 800-778-4215 Fax: (615) 253-7794 * Denotes Required Fields CONSUMER COMPLAINT The Tennessee Department of Financial Institutions requires that complaints be written. The Department provides this form with the understanding that you authorize this office to conduct an investigation to determine if a violation of Tennessee law has occurred. *Your Name: Your Email: *Address: *City: *State: *Zip Code: *County: *Home Phone: Work Phone: Who Is Your Complaint Against? If Complaint involves a Mortgage Loan, Please advise if it is: Investment Property Owner Occupied Name of Individual: Position of Individual: *Name of Financial Institution: *Address: *City: *State: *Zip: Phone: Amount Involved: Method of Payment *Date of Transaction: Type of Transaction or Service: Have you: *Contacted the financial institution? Yes No Please provide the name of the person you spoke to at the financial institution, as well as the date(s) of contact. What efforts have you taken to resolve your dispute with the financial institution? *Retained an attorney? Yes No If yes, please provide the name and address of the attorney Attorney Phone: *Has a lawsuit been filed: Yes No If yes, please provide the case or docket number: What settlement would you consider fair: * State briefly your complaint. Complete information will speed action on your complaint. Do you have supporting documentation? Yes No If yes, please provide copies of your original documents (attach to a copy of this complaint) within five business days of sending this complaint electronically. By submitting this information, I hereby attest to the accuracy or truthfulness of the content. I authorize the Department of Financial Institutions to send this complaint form to the financial institution or use the information given in any other manner deemed necessary or proper Yes No
STATE OF TENNESSEE DEPARTMENT OF FINANCIAL INSTITUTIONS CONSUMER RESOURCES DIVISION 414 UNION STREET, SUITE 1000 NASHVILLE, TENNESSEE 37219 Phone: 800-778-4215 Fax: (615) 253-7794
* Denotes Required Fields
The Tennessee Department of Financial Institutions requires that complaints be written. The Department provides this form with the understanding that you authorize this office to conduct an investigation to determine if a violation of Tennessee law has occurred.
*Your Name:
Your Email:
*Address:
*City: *State: *Zip Code: *County:
*Home Phone: Work Phone:
Who Is Your Complaint Against?
If Complaint involves a Mortgage Loan, Please advise if it is: Investment Property Owner Occupied
Name of Individual:
Position of Individual:
*Name of Financial Institution:
*City: *State: *Zip: Phone:
Amount Involved: Method of Payment
*Date of Transaction: Type of Transaction or Service:
Have you: *Contacted the financial institution? Yes No
Please provide the name of the person you spoke to at the financial institution, as well as the date(s) of contact.
What efforts have you taken to resolve your dispute with the financial institution?
*Retained an attorney? Yes No
If yes, please provide the name and address of the attorney Attorney Phone: *Has a lawsuit been filed: Yes No If yes, please provide the case or docket number:
What settlement would you consider fair:
* State briefly your complaint. Complete information will speed action on your complaint. Do you have supporting documentation? Yes No If yes, please provide copies of your original documents (attach to a copy of this complaint) within five business days of sending this complaint electronically. By submitting this information, I hereby attest to the accuracy or truthfulness of the content. I authorize the Department of Financial Institutions to send this complaint form to the financial institution or use the information given in any other manner deemed necessary or proper Yes No
Do you have supporting documentation? Yes No If yes, please provide copies of your original documents (attach to a copy of this complaint) within five business days of sending this complaint electronically.
By submitting this information, I hereby attest to the accuracy or truthfulness of the content. I authorize the Department of Financial Institutions to send this complaint form to the financial institution or use the information given in any other manner deemed necessary or proper Yes No
