STATE OF TENNESSEE
DEPARTMENT OF FINANCIAL INSTITUTIONS
CONSUMER RESOURCES DIVISION
414 UNION STREET, SUITE 1000
NASHVILLE, TENNESSEE 37219
Fax: (615) 253-7794
* Denotes Required Fields
The Tennessee Department of Financial Institutions requires that complaints be written. The Department provides this form with the understanding that you authorize this office to conduct an investigation to determine if a violation of Tennessee law has occurred.
Who Is Your Complaint Against?
If Complaint involves a Mortgage Loan, Please advise if it is:
Name of Individual:
Position of Individual:
*Name of Financial Institution:
Method of Payment
*Date of Transaction:
Type of Transaction or Service:
*Contacted the financial institution?
Please provide the name of the person
you spoke to at the financial institution,
as well as the date(s) of contact.
efforts have you taken to resolve your dispute with the financial institution?
*Retained an attorney?
If yes, please provide
the name and address of the attorney
*Has a lawsuit been filed:
If yes, please
provide the case or docket number:
What settlement would you consider fair:
*State briefly your complaint.
Complete information will speed action on your complaint.
Do you have supporting documentation? Yes
If yes, please provide copies of your original documents (attach to a copy of this
complaint) within five business days of sending this complaint
By submitting this information, I hereby attest to the accuracy or truthfulness of the content. I authorize the Department of Financial Institutions to send this complaint form to the financial institution or use the information given in any other manner deemed necessary or proper.
Please print this page before clicking on the Submit button below.