DFI Consumer Complaint Form

1) General Information

I understand DFI cannot provide legal advice or act as my lawyer *

By submitting this complaint, I understand that the DFI cannot answer legal questions or give legal advice to me and cannot act as my personal lawyer.

What is this complaint about? *

For our statistics, please share your age

Where did you learn about DFI to file this complaint? *

What is your preferred language?

Are you submitting this information on behalf of someone else? *

Yes

No

If you are submitting this complaint on behalf of someone else, please provide a signed letter from that person indicating permission to communicate with you.

2) Your Information

Your name *

Mailing address *

City *

State *

Zip *

Phone *

Email *

3) Complaint Information

Company (or individual) you’re complaining about *

Have you complained directly to the person or business? *

Yes

No

Who did you talk to?

Enter the name(s) of any people you talked to

Company address

Company city

Company state

Company zip

Company phone

Company email/website

Transaction date(s) & amount(s)

Have you contacted any other regulator? *

Yes

No

If yes, who?

Do you have any documentation about your complaint? *

Yes

No

If yes, please describe

Describe your problem or complaint *

Please provide as many details as possible, including names, dates, and any steps you've taken.

Whistleblower

Investments, Securities Brokers or Investment Adviser Complaints Only: Whistleblower Award and Protection Act

Please select this option if you wish to be considered a whistleblower under the Whistleblower Award and Protection Act, chapter 21.40 RCW. The identity of a whistleblower is protected from public disclosure pursuant to RCW 42.56.400(6). An individual who wishes to make an anonymous whistleblower complaint must be represented by counsel. Individuals that make whistleblower complaints or that report potential securities law violations to their employer are protected from retaliation pursuant to the Act.

4) Public Records Disclosure

Public Records Disclosure

Prevent my identifying information from being shared in a Public Records Act request.

Public Records Disclosure The Washington Public Records Act (PRA), RCW 42.56, may require disclosure of this complaint in response to a public records request. If you choose, you may prevent your identifying information from being shared under the PRA. Please note that this does not necessarily restrict the release of your identifying information pursuant to a court order, subpoena, or during litigation. If you opt to not share your information in a PRA request, DFI may still need to share your complaint – including identifying information – with the business or person in your complaint during any investigation or if we refer your complaint to another agency.