Payday Loan Complaint Form

Submitted by Anonymous on Mon, 2017-08-07 13:16

We have found complaints can normally be resolved if the consumer contacts the company directly. If you have not already done so, please contact the company and attempt to resolve the problem.

If direct contact is unsuccessful or you are not satisfied with the results, please fill out this form and send it, along with any copies of the company’s response and any other appropriate documentation, to the Division of Consumer Services.

Your Complaint will be promptly acknowledged, and you will be notified of the final disposition.

Your Information

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.

Keep information exempt

Do not keep information exempt

Full Name(s) *

Mailing Address *

City *

State *

Zip *

Physical Address (if different)

Email *

Phone *

Preferred method of contact *

Phone

Mail

Are you on active duty in the armed forces or a dependent *

Yes

If you are submitting this complaint on behalf of someone else can you provide a signed authorization from that person?

Yes

Disputed Payday Loan Company Contact Information:

Information about the company with which you have disputed a transaction(s):

Company Name *

Company Address

Company City

Company State

Company Zip

Company Phone Number

Who You Contacted

Company Email

Company Website

Did you use the Internet to obtain the loan?

Yes

Website address used to obtain the loan

Attorney Information

Do you have an attorney? *

Yes

Attorney Name

Attorney Address

Attorney City

Attorney State

Attorney Zip

Disputed Payday Loan Transaction Description and Details

Provide a description of the problem *

Amount of loan before fees

Amount of fees paid

Date of Transaction

Has the matter been submitted to another agency?

Yes

Agency name

Result of that complaint

Is a court action pending for this matter?

Yes

Have you tried to resolve your complaint?

Yes

Who you contacted

Date(s) of contact

Other method of contact

Phone of who you contacted

What do you think will resolve this problem for you?

Disputed Payday Loan Transaction History

How did you receive the loan funds?

How many days were you given to repay the loan?

How were you supposed to pay the company back?

(ACH, Direct withdrawal, cash, postdated check, other)

Did they ask you to pay with more than one check?

Yes

Did you default?

Yes

Did you complete an application?

Yes

Did you complete a loan agreement?

Yes

Did you complete any other forms?

Yes

Did anyone explain or discuss the terms of the loan with you?

Yes

Did you experience difficulty locating or accessing a physical office of a licensed payday lender in Washington?

Yes

Can you provide a copy of your loan documents?

Yes

Did you request a payment plan?

Yes

Did you obtain a payment plan?

Yes

* If any of the above answers are “yes” we may request a copy of that item

Identify Additional Problems You Are Having With The Company

Did You Obtain A Payday Loan Via The Internet?

Other reason you used internet to obtain a payday loan

Declaration

By filling in my name and 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.

Full Name *

Today's Date *

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