Compliant Form - Idaho

This Idaho-specific "Compliant Form" is a document released by the Idaho Department of Finance.

Download the fillable PDF by clicking the link below and use it according to the applicable legal guidelines.

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C.L. "BUTCH" OTTER
Governor
GAVIN M. GEE
Director
Dear Consumer:
Attached is the Complaint Form you requested. Please complete this form, enclose copies of any documents
relating to the problem, and return it to our address as shown on this letter.
The Idaho Department of Finance cannot act as a private attorney for you and you should not rely on us to obtain a
resolution to your complaint that is satisfactory to you. Our role in any legal action is on behalf of all the people of
Idaho. We will consider investigating complaints involving an ongoing pattern or practice of illegal activity. We rely
in great part upon consumers who are willing to provide us with information about fraudulent and deceptive
activities in tracking illegal business practices. Information from consumers, such as yourself, allows us to identify
and devote our resources to the most serious cases involving widespread injury to Idaho's consumers. Within the
limits of our resources, we bring lawsuits or other actions in such cases. Information provided by consumers like
you is indispensable to our efforts.
Unless you specifically request otherwise, we will attempt to mediate your dispute by forwarding your complaint to
the business or person involved, requesting a response. We will forward information we receive to you. There are
several other options available to you in attempting to resolve your complaint:
(1)
Your local Better Business Bureau may be able to assist you in mediating a dispute with a business;
(2)
You may want to file an action in Small Claims Court if the amount in controversy is less than $5,000;
(3)
If the amount in controversy is more than $5,000, you may have a remedy available to you through a
private attorney. If you do not have a private attorney, you may want to contact the Idaho State Bar Lawyer
Referral Service at: Idaho State Bar, P.O. Box 895, Boise, Idaho 83701, (208) 334-4500. The Idaho State
Bar and Idaho Law Foundation, Inc.’s website is www2.state.id.us/isb/.
(4)
Depending upon household income and other factors, you may qualify for legal assistance from the Idaho
Volunteer Lawyers Association. Their contact information is provided through the Idaho State Bar.
Your complaint will become part of our permanent file concerning the business or person identified, and will assist
us in determining the need for further action by this office.
Please be advised that your complaint may be a public document and if so, may be inspected by members of the
public and media if a request is made under Idaho's Public Records Law. Your time in submitting this information is
appreciated.
Sincerely,
THE IDAHO DEPARTMENT OF FINANCE
FINANCIAL INSTITUTIONS BUREAU
800 Park Blvd, Suite 200, Boise, ID 83712
Mail To: P.O. Box 83720, Boise ID 83720-0031
Phone: (208) 332-8002 Fax: (208) 332-8096
http://finance.idaho.gov
PROTECTING THE INTEGRITY OF IDAHO FINANCIAL MARKETS SINCE 1905
C.L. "BUTCH" OTTER
Governor
GAVIN M. GEE
Director
Dear Consumer:
Attached is the Complaint Form you requested. Please complete this form, enclose copies of any documents
relating to the problem, and return it to our address as shown on this letter.
The Idaho Department of Finance cannot act as a private attorney for you and you should not rely on us to obtain a
resolution to your complaint that is satisfactory to you. Our role in any legal action is on behalf of all the people of
Idaho. We will consider investigating complaints involving an ongoing pattern or practice of illegal activity. We rely
in great part upon consumers who are willing to provide us with information about fraudulent and deceptive
activities in tracking illegal business practices. Information from consumers, such as yourself, allows us to identify
and devote our resources to the most serious cases involving widespread injury to Idaho's consumers. Within the
limits of our resources, we bring lawsuits or other actions in such cases. Information provided by consumers like
you is indispensable to our efforts.
Unless you specifically request otherwise, we will attempt to mediate your dispute by forwarding your complaint to
the business or person involved, requesting a response. We will forward information we receive to you. There are
several other options available to you in attempting to resolve your complaint:
(1)
Your local Better Business Bureau may be able to assist you in mediating a dispute with a business;
(2)
You may want to file an action in Small Claims Court if the amount in controversy is less than $5,000;
(3)
If the amount in controversy is more than $5,000, you may have a remedy available to you through a
private attorney. If you do not have a private attorney, you may want to contact the Idaho State Bar Lawyer
Referral Service at: Idaho State Bar, P.O. Box 895, Boise, Idaho 83701, (208) 334-4500. The Idaho State
Bar and Idaho Law Foundation, Inc.’s website is www2.state.id.us/isb/.
(4)
Depending upon household income and other factors, you may qualify for legal assistance from the Idaho
Volunteer Lawyers Association. Their contact information is provided through the Idaho State Bar.
Your complaint will become part of our permanent file concerning the business or person identified, and will assist
us in determining the need for further action by this office.
Please be advised that your complaint may be a public document and if so, may be inspected by members of the
public and media if a request is made under Idaho's Public Records Law. Your time in submitting this information is
appreciated.
Sincerely,
THE IDAHO DEPARTMENT OF FINANCE
FINANCIAL INSTITUTIONS BUREAU
800 Park Blvd, Suite 200, Boise, ID 83712
Mail To: P.O. Box 83720, Boise ID 83720-0031
Phone: (208) 332-8002 Fax: (208) 332-8096
http://finance.idaho.gov
PROTECTING THE INTEGRITY OF IDAHO FINANCIAL MARKETS SINCE 1905
Idaho Department of Finance
Complaint Form
WHEN COMPLETING THIS FORM, PLEASE TYPE OR PRINT AS CAREFULLY AS POSSIBLE
SO THE INFORMATION MAY BE EASILY READ AND UNDERSTOOD.
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 the transaction,
such as loan applications, collection letters or any other pertinent documentation to aid us in helping you. Do not
send original documents that you would like returned.
Mail or fax this completed complaint form with any attachments to:
IDAHO DEPARTMENT OF FINANCE
800 PARK BOULEVARD, SUITE 200
P.O. BOX 83720
BOISE, ID 83720-0031
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
A
C
I
DDITIONAL
ONTACT
NFORMATION
If you want us to communicate with someone else, such as a family member, attorney, or other person
representing you about this complaint, 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
about you to that person.
Name of Representative:
Relationship:
Street Address:
City:
State:
Zip:
-
Phone:
F
I
C
I
INANCIAL
NSTITUTION OR
OMPANY
NFORMATION THAT IS SUBJECT OF THE
C
OMPLAINT
Name of Financial Institution or Company:
Street Address:
City:
State:
Zip:
-
Phone:
Type of Account(s): Credit Card:
Checking
Mortgage
Other:
Mortgage
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?
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.
D
R
ESIRED
ESOLUTION
What action by the financial institution or company would resolve this matter to your satisfaction?
P
A
S
RIVACY
CT
TATEMENT
I certify that the information provided on this form is true and correct to the best of my knowledge. I
understand that the Department of Finance cannot act as my private attorney, but rather acts on behalf of
the public by enforcing laws governing financial institutions, regulated lenders and collection agencies
when it is in the public interest to do so. I understand that the Department of Finance does not represent
private citizens seeking the return of their money or other personal remedies. I am, however, filing this
complaint to notify the Department of Finance of the activities of this company. I understand that the
information contained in this complaint may be used to establish violations of Idaho law in both private and
public enforcement actions.
Once completed and submitted, this complaint may be a public document and if so, may be
inspected by members of the public and media if a request is made under Idaho’s Public Records
Law.
Signature:
Date:
___
___

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