Consumer Complaint Form
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Mail or fax this completed complaint form with any attachments to:
Commonwealth of Massachusetts Division of Banks
Attn: Consumer Assistance Unit
1000 Washington Street, 10th floor
Boston, MA 02118-2218
Telephone: (617) 956-1500
Fax: (617) 368-2700
Credit Card complaints are to be directed to the Consumer Protection Financial Bureau (CFPB)
The CFPB was established by the Dodd-Frank Wall Street Reform and Consumer Protection Act of 2010. The CFPB conducts rule-making, and has supervision and enforcement for federal consumer financial protection laws.
Credit card complaint line: (855) 411-CFPB (2372)
Linea de asistencia para su tarjeta de crédito: (855) 411-CFPB (2372)
TTY/TDD: (855) 729-CFPB (2372)
CFPB credit card complaint form
Please Note:
- The Division of Banks cannot act as a court of law or as a lawyer on your behalf.
- We cannot give you legal advice.
- We cannot become involved in complaints where you are represented by an attorney, are in litigation, or have been litigated.
- The Division of Banks cannot become involved in disputes between business entities and a financial institution.
YOUR INFORMATION
Salutation: Mr. __ Ms. __ Mrs. __ Other: ________________________________
First Name: _____________________________________ Middle Initial: ______
Last Name: ______________________________________________________
Street Address: ___________________________________________________
City: _____________________________ State: ________ ZIP: ______________
Home Phone: ___________________________________________________
Work Phone: ___________________________________________________
Email: __________________________________________________________
What is the best way to contact you? Phone __ Mail __ Email __
What is the best time to contact you? Morning __ Afternoon __ Evening __
ADDITIONAL CONTACT INFORMATION
If you want us to communicate with someone else, such as a family member or other person representing you about this complaint, then please provide your representative's information below. If you list someone else and sign this form, you allow us to communicate with and provide relevant information that is about you to that person.
Name of Representative: ____________________________________________
Relationship: _____________________________________________________
Street Address: ___________________________________________________
City: _____________________________ State: ________ ZIP: _____________
Phone: __________________________________________________________
FINANCIAL INSTITUTION OR COMPANY INFORMATION THAT IS SUBJECT OF THE COMPLAINT
Name of Financial Institution or Company: ______________________________
Street Address: ___________________________________________________
City: _____________________________ State: ________ ZIP: _____________
Phone: __________________________________________________________
Type of Complaint: ________________________________________________
Have you tried to resolve your complaint with your financial institution or company?
Yes __ No __
If Yes, When? _______________________________________
How? Phone __ Mail __ In Person __ Other ________________________
Contact Name: ____________________________________________
Title: ____________________________________________________
Have you filed a complaint or contacted another government agency?
Yes __ No ___
If Yes, Agency Name? ________________________________________________
COMPLAINT INFORMATION
Describe events in the order in which they occurred, including any names, phone numbers, and a full description of the problem with the amount(s) and date(s) of any transaction(s). You should also include any response from the financial institution or company.
Be as brief and complete as possible to make the explanation clear. Use separate sheet(s) of paper if you need more space.
Please include COPIES of documents related to your complaint such as contracts, monthly statements, receipts and correspondence with the bank. DO NOT SEND ORIGINAL DOCUMENTS.
Please be advised that the issues described in this complaint will be shared with the financial institution or company in question for their response.
DESIRED RESOLUTION
What action by the financial institution or company would resolve this matter to your satisfaction?
I certify that the information provided on, or with, this form is true and correct to the best of my knowledge.
Signature: _______________________________________________________
Date: ___________________________________________________________