Money Transmitter Complaint Form - Idaho

This Idaho-specific printable "Money Transmitter Complaint Form" is a part of the legal paperwork issued by the Idaho Department of Finance.

Download the up-to-date PDF by clicking the link below and mail it as per the guidelines provided by the department.

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IDAHO DEPARTMENT OF FINANCE
Securities Bureau
800 Park Blvd., Suite 200, Boise, ID 83712
P.O. Box 83720, Boise, ID 83720-0031
http://www.finance.idaho.gov
Fax: 208/332-8099
Phone: 208/332-8004
Toll Free within Idaho: 1-888-346-3378
E-mail: securities@finance.idaho.gov
GUIDELINES FOR COMPLETING THE MONEY TRANSMITTER COMPLAINT FORM
Before filling out the attached complaint form, please take the time to read these guidelines; they will help you understand
our functions, and we will be better able to understand and act on your complaint.
WHAT WE CAN DO:
We investigate complaints against persons, business entities, and corporations accused of violating the licensing or anti-
fraud provisions of laws administered by the Department. We are empowered to bring administrative or civil actions to
stop these violations, and, in appropriate cases, to refer matters to the Prosecuting Attorneys' offices for criminal
prosecution.
WHAT WE CANNOT DO:
We cannot act as a court of law, so we cannot order that monies be refunded, contracts be canceled or damages be
awarded. If you have this type of problem, you should consult an attorney.
We cannot give legal advice or act as your attorney.
HOW YOU CAN HELP US:
The purpose of this complaint form is to provide this Department with enough information to allow us to determine if an
investigation into your allegations is warranted. Thus, it is important for you to furnish as much detailed information as
possible.
Documentary evidence is especially important; therefore, if you have documents that support your complaint statements –
mail your completed complaint along with copies of all documents to the Department. (Please do not send originals; we
cannot be responsible for their safekeeping.)
How to submit complaint form and supporting documents:
You may complete all sections of this fillable form, save, print and sign. Then scan and email it along with your scanned
supporting documents to:
securities@finance.idaho.gov
or mail photocopied form and supporting documents to address
below.
Or
You may print form, complete by hand (print clearly) and sign. Then mail along with your photocopied supporting
documents to:
Idaho Department of Finance
Securities Bureau
P.O. Box 83720, Boise, ID 83720-0031
or
Express: 800 Park Blvd., Suite 200, Boise, ID 83712
If you have any questions concerning this form, you may contact the Securities Bureau at 208/332-8004.
IDAHO DEPARTMENT OF FINANCE
Securities Bureau
800 Park Blvd., Suite 200, Boise, ID 83712
P.O. Box 83720, Boise, ID 83720-0031
http://www.finance.idaho.gov
Fax: 208/332-8099
Phone: 208/332-8004
Toll Free within Idaho: 1-888-346-3378
E-mail: securities@finance.idaho.gov
GUIDELINES FOR COMPLETING THE MONEY TRANSMITTER COMPLAINT FORM
Before filling out the attached complaint form, please take the time to read these guidelines; they will help you understand
our functions, and we will be better able to understand and act on your complaint.
WHAT WE CAN DO:
We investigate complaints against persons, business entities, and corporations accused of violating the licensing or anti-
fraud provisions of laws administered by the Department. We are empowered to bring administrative or civil actions to
stop these violations, and, in appropriate cases, to refer matters to the Prosecuting Attorneys' offices for criminal
prosecution.
WHAT WE CANNOT DO:
We cannot act as a court of law, so we cannot order that monies be refunded, contracts be canceled or damages be
awarded. If you have this type of problem, you should consult an attorney.
We cannot give legal advice or act as your attorney.
HOW YOU CAN HELP US:
The purpose of this complaint form is to provide this Department with enough information to allow us to determine if an
investigation into your allegations is warranted. Thus, it is important for you to furnish as much detailed information as
possible.
Documentary evidence is especially important; therefore, if you have documents that support your complaint statements –
mail your completed complaint along with copies of all documents to the Department. (Please do not send originals; we
cannot be responsible for their safekeeping.)
How to submit complaint form and supporting documents:
You may complete all sections of this fillable form, save, print and sign. Then scan and email it along with your scanned
supporting documents to:
securities@finance.idaho.gov
or mail photocopied form and supporting documents to address
below.
Or
You may print form, complete by hand (print clearly) and sign. Then mail along with your photocopied supporting
documents to:
Idaho Department of Finance
Securities Bureau
P.O. Box 83720, Boise, ID 83720-0031
or
Express: 800 Park Blvd., Suite 200, Boise, ID 83712
If you have any questions concerning this form, you may contact the Securities Bureau at 208/332-8004.
Money Transmitter Complaint Form
WHEN COMPLETING THIS FORM, PLEASE TYPE OR PRINT AS CAREFULLY AS POSSIBLE
Prior to filing this complaint, we request that you contact the company or individual against whom you are
complaining and attempt to resolve your dispute. If this proves unsuccessful, please complete this form and
return it to the Department of Finance. It is important that you enclose copies of documents relating to your
complaint.
Mail or fax this completed complaint form with any attachments to:
IDAHO DEPARTMENT OF FINANCE
Securities Bureau
P.O. Box 83720, Boise, ID 83720-0031
Express: 800 Park Blvd, Suite 200, Boise, ID 83712
Fax: 208-332-8099
Y
I
OUR
NFO RMATION
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
S
C
UBJECT OF
OMPLAINT
Name of Financial Institution or Person:
Street Address:
City:
State:
Zip:
Phone:
Have you tried to resolve your complaint? Yes
No
If Yes, When?
How? Phone
Mail
In Person
Other
Contact Name:
Title:
Phone:
Have you filed a complaint or contacted another government agency? Yes
No
If Yes, Agency Name?
2
C
I
OMPLAINT
NFORMATION
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
of documents related to your complaint such as contracts, monthly statements,
COPIES
receipts and correspondence with the company.
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.
Signature:
Date:
___
___
3

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