Consumer Complaint Form

Describe events in the order they occurred, including any names, phone numbers, and full description of the problem with the amount(s) and date(s) of any transaction(s). Be as brief and complete as possible to make the explanation clear. Do not include personal or confidential information such as your social security, credit card, or account number.
Please type your name as your signature At your request, we are initiating a review of your account, which will include a review of your personal inforamation, including but not limited to, your personal account with our institution or any affiliates, your personally identifying information, and any other private information required to respond sufficiently to your request. We respect your privacy and will not share the information you have provided or any information we obtain in connection with responding to your complaint with parties not authorized to receive the information, except as allowed by applicable law. By submitting this complaint, you either request or authorize us to review your personal information included on this form and contained in other records in order to investigate and respond to your submitted complaint. By signing beliw, you certify that the information provided on this form is true and correct ot the best of your knowledge.

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