Complaint Form

Important Notice: Disclosure of this information is voluntary. However, failure to supply complete information may result in this complaint not being processed. If you have additional materials relevant to your complaint (contracts, billing statements, collection agency letters, etc.) please mail them to us separately. Do not send original documents. Please be advised the issues described in this complaint will be shared with the Respondent.

The Bureau cannot act on your behalf in court or as a lawyer, give legal advice, or become involved in complaints that are in litigation or have been litigated.

1. Who is the complaint against?

Business Name (required)
Street Address
City State ME AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VT WA WI WV WY ZIP
Telephone (e.g.,. 207-555-1111)
Account Number (Required. 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 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"). To file a complaint with the CFPB, CLICK HERE (Trusted Partner Link).

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. (required)

What would you like the business to do to resolve your complaint?

4. Information About You

Title

Mr. Ms. Mrs.
First Name (required)
Middle Initial
Last Name (required)
Street Address (required)
City (required) State ME AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VT WA WI WV WY ZIP (required)
Country United States Canada Other
Telephone (Daytime) (e.g., 207-555-1111) ext.
Telephone (Evening) (e.g., 207-555-1111)
Fax Number (e.g., 207-555-1111) Email Address (required)

Today's Date

Month Month January February March April May June July August September October November December Day Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2024 2025 2026

5. Customer Authorization

Authorization I certify the information provided on or with this form is true and correct to the best of my knowledge. I hereby request the Bureau conduct a review of my complaint. To assist with this review, I authorize any person or entity in connection with this complaint to provide relevant information.
Yes No

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