Washington State Department of Financial Institutions

Washington State Payday Loan Complaint Form

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

If you do not live in Washington State, we may not be able to help you with your complaint. Please review the NMLS state contacts website to find your state’s office of financial regulation.

If you wish to file a complaint about collection agencies making harassing calls, please see our news release regarding debt collection scams.

* Denotes a required field

Your Information and Description of Problem

Public Records Disclosure Act:

The Washington State 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 Name(s)
* Mail Address
* City * State
* Zip
* Phone
Cell Work
Email

* Is your home address different than the mailing address listed above?
Yes No

Home Address
City State  
Zip

* Are you on activity duty in the armed forces or a dependent?
Yes No

If you used the internet to take out a payday loan, please identify the reasons why you used the internet:

I like the convenience
No hassles – don’t need many pieces of identification
There is no credit check
I reached my 8 loan limit under Washington law
I like using online vendors for most of my shopping I can get my money sooner
I can get more money than I can elsewhere
I am embarrassed to go to a store and have to talk with someone
I can get as many loans as I want online
I tried to use other sources to get money such as my bank or credit union, but couldn’t get the money I needed
My credit cards are maxed out
Other. Please Explain:

* Provide a concise description of the problem

Can’t contact lender. The online company won’t give me any information and their address or phone number is not working
ACH: I paid the lender back but they continue to take money from my account
ACH: The lender debited my account on the wrong date
Lender won’t give me an installment/payment plan
Fees were charged and no service or loan was actually received
I got a loan I didn’t apply for. The company on the Internet gave me a loan I did not apply for and now they are taking money from my account.
I was charged excessive fees
I was charged excessive interest
I am getting harassing phone calls
I am being threatened with criminal action
They are showing up at my work/home
My family members are being threatened
I paid my loan, but they are still collecting
Collection agency won’t provide proof of debt
I did not have a loan with this company
I reached my 8 loan limit and I need another loan
I reached my $700 loan amount limit and I need a larger loan
My complaint is against Veritec (statewide payday loan database)
Other, please provide explanation below:

Disputed Payday Loan Transaction Details

* Date of disputed transaction
(month/day/year)

Questions

1) Did you complete an application? Yes No
a) Can you provide a copy of the application?
Yes No
b) Comments about the application
2) Did you complete a loan agreement? Yes No
a) Can you provide a copy of the agreement?
Yes No
b) Comments about the loan agreement
3) Did you complete any other forms? Yes No
a) Can you provide a copy of the other forms?
Yes No
b) Comments about the other forms
4) Did you receive any other paperwork? Yes No
a) Can you provide a copy of the other disclosures?
Yes No
b) Comments about the other forms
5) Did anyone explain or discuss the terms
of the loan with you? 		Yes No
a) What did they say?

Disputed Payday Loan Transaction, Company Contact Information

Information about the company you have disputed transaction(s) with.

* Name(s) of lender
Email address(es)
used or provided by company
* Physical addresses
used or provided by company
Did you use the internet to obtain a payday loan because you were denied due to the 8 loan per 12 month limit? Yes No
Website address(es)
Used to obtain the loan
Did you talk to any employees? Yes No

Who did you talk to at the payday loan company?

Name(s)
Title(s)
Date(s) of discussion
Did you get a business card? Yes No
a) Can you provide a copy of the business card?
Yes No
Please provide any other details of your conversation. What did they say?

Disputed Payday Loan Transaction History

Transaction 1

Payday Loan Company Name
Can you provide a copy of your loan documents?
Yes No
Transaction Date Loan Amount
(before fees)		 Fees Paid Did you default? How long were you given to pay back the loan?
$ $ Yes No

Transaction 2

Payday Loan Company Name
Can you provide a copy of your loan documents?
Yes No
Transaction Date Loan Amount
(before fees)		 Fees Paid Did you default? How long were you given to pay back the loan?
$ $ Yes No

Transaction 3

Payday Loan Company Name
Can you provide a copy of your loan documents?
Yes No
Transaction Date Loan Amount
(before fees)		 Fees Paid Did you default? How long were you given to pay back the loan?
$ $ Yes No
How did you receive the loan funds?
How were you supposed to pay
the company back? (ACH, direct
withdrawal, cash, postdated check, etc.)
Did they ask you to pay with
more than one check?		 Yes No
How many?
Amount $

Payment Plan/Installment Plan Details

Did you request a payment plan?
Yes No
Did you obtain a payment plan?
Yes No
a) Date you obtained payment plan
b) What were the terms of the payment plan?
c) Did they ask for more than one check from you to start the payment plan?
Yes No
i) How many?
ii) Amount $
iii) Can you provide us a copy of the checks?
Yes No
d) Did you enter into a contract for the payment plan?
Yes No
i) Can you provide us a copy?
Yes No

Other Fees

Did you pay any other fees related to the payment plan (such as insufficient funds, or attorney fees?
Yes No
a) Can you provide us a copy of the checks and notices?
Yes No
b) How much were the fees and what were they for?
Amount $
Reason(s)

Collection Questions

1) Are you or have you ever been delinquent with payments to this company?
Yes No
a) When? (Date)
b) Who contacted you? How did they contact you? How did they identify themselves?
c) Who do you believe contacted you?
2) Did you ever receive a written notice or letter for being delinquent on your loan(s)?
Yes No
a) If yes, can you provide a copy of this information?
Yes No
3) Did they threaten you (i.e. threaten criminal charges, says you were guilty of fraud, say you would be arrested, etc?)
Yes No
a) How did they threaten you (i.e. during phone calls, in person, or in writing)?


b) What did they say?
4) Do you have any logs or records of the calls or correspondence?
Yes No
a) Can you provide us a copy of the logs or records?
Yes No
5) Were you taken to small claims court?
Yes No
a) What was the case number and what was the result
6) Do you know of anyone else (friends, family) who could provide us with additional information regarding this company?
Yes No
a) Provide names and relationship to this person and their contact information (1 per line, please)
7) Is there anything else you would like to tell us about your experience(s) with this company?

Attorney Information

* Do you have an attorney?
I do not have an attorney
I have an attorney

I would like you to work directly with my attorney
Attorney Name
Firm
Address
City State
Zip
Phone
Fax
Email

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