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Confidential Complaint Form

If you have additional materials relevant to your complaint (contracts, billing statements, collection agency letters, etc.) please mail them to us separately.

Please note: Although it is most unlikely that you will experience any problems using this form, certain non-standard browsers will not respond properly. If you experience any difficulties, (or if you are not using a forms-capable browser) you may send an email to:Tammie L. Breton

Disclaimer: We cannot process your complaint unless you first have contacted the business and tried to resolve the issue on your own.

1. Who is the complaint against


Firm Name
Street Address
City
State
ZIP
Telephone	(e.g.,. 207-555-1111)
Account Number	(If unknown, please enter unknown)
If you are not a resident of Maine, is your complaint against a Maine-based company?

Yes No	If you have checked "No," please keep in mind that we are a state regulatory agency that handles complaints relating to the State of Maine. Please consider contacting your own state's Attorney General's office. If you are trying to reach the new federal agency that is known by a name similar to ours (the "Consumer Financial Protection Bureau," or CFPB), then click here to file a complaint with the federal CFPB.

2. Name of the primary person you dealt with

(Please list any additional people in the complaint details area.)

First Name
Middle Initial
Last Name

3. Complaint


Please provide us with the details of your complaint. Please be as specific as possible. If this complaint relates to a debt, include the amount owed.


May we send a copy of this complaint to the company?

Yes No
If you checked "No," please explain briefly why you do not want us to share your written complaint with the company you are complaining against:



What would you like us to do to resolve your complaint?

4. Customer Authorization


Do you authorize the Bureau of Consumer Credit Protection to act on your behalf to communicate with your creditors or other businesses, obtain documents from those businesses and take all appropriate steps to respond to your complaint?
Yes No

5. Information About You

Title	Mr. Ms Mrs.
First Name
Middle Initial
Last Name
Street Address
City
State
ZIP
Country
Telephone (Daytime) (e.g., 207-555-1111)	ext.
Telephone (Evening)	(e.g., 207-555-1111)
Fax Number	(e.g., 207-555-1111)
Email Address
Today's Date

Maine.gov

Confidential Complaint Form