Screenshot of New Complaint form

Who are you submitting this complaint for?
 Myself

I am submitting this complaint
for myself

 Someone else

The consumer has authorized me to
submit this complaint for them

Your contact information
Enter your information so the company can respond to you about
this complaint.

This will create your secure online account where you
can see your complaint, status information, and the
company's response.
Without an email address, you’ll have to wait for updates
to arrive by mail or call our contact center to hear the
company’s response.

Re-enter your email address

I don’t have an email address.

Your demographic information
 Help us identify problems affecting different consumers
Information about consumers helps us understand the types of problems different
consumers have with financial products and services. By providing the information
requested below, you can help us spot patterns affecting servicemembers and
their families and consumers of different ages, household sizes, and incomes.

Age (optional)

Servicemember status (optional)

Household size including total number of adults and children (optional)

Combined annual household income (optional)

Who are you submitting this complaint for?
 Myself

I am submitting this complaint
for myself

 Someone else

The consumer has authorized me to
submit this complaint for them

Your information
You must identify yourself to submit this complaint to the Consumer
Financial Protection Bureau.

Relationship to the consumer you are submitting a complaint for

Email

Re-enter your email address

If you are the consumer’s authorized third party, we will use your email
address to provide you with status updates. Companies are expected
to respond to complaints submitted by authorized third parties;
however, because we are unable to provide third parties with a copy of
the company’s written response you will need to call us to hear how the
company responded. Companies generally require signed, written
permission from the consumer before providing a response to third
party complaints. If you want to attach signed written authorization
from the consumer, go back to Step 3.

The consumer’s contact information
Enter the consumer’s information so the company can respond to
them about this complaint.

This will create a secure online account where the
consumer can see their complaint, status information, and
the company's response.
Without an email address, they’ll have to wait for updates
to arrive by mail or call our contact center to hear the
company’s response.

Re-enter the consumer’s email address

The consumer does not have an email address.

Consumer’s demographic information
 Help us identify problems affecting different consumers
Information about consumers helps us understand the types of problems different
consumers have with financial products and services. By providing the information
requested below, you can help us spot patterns affecting servicemembers and
their families and consumers of different ages, household sizes, and incomes.

Age (optional)

Servicemember status (optional)

Household size including total number of adults and children (optional)

Combined annual household income (optional)