Collection Agency Complaint

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Collection Agency Complaint
You can use this form to file a complaint against a service provider or professional licensee. If you have any questions
about collection agencies, call (360) 664-6652.
Fax your complaint and the required enclosures to (360) 570-7098, email to DFCcompliance@dol.wa.gov, or mail to:
Collection Agencies Board
Department of Licensing
PO Box 9012
Olympia WA 98507-9012
Enclose the following:
• A detailed explanation of your complaint; this must include dates, other parties involved, and a summary of any efforts
you have already made to resolve the problem. Describe events in the order they occurred.
• Copies of all documents that relate to the complaint.
Business or person you are filing a complaint about
PRINT or TYPE Profession or type of business
Collection agency
Service provider or professional licensee name (Last, First, Middle)
License number (if known)
Business name
(Area code) Telephone number and extension
(Area code) Fax number
email or web address
Business address
City
State
ZIP code
Your contact information
Name (Last, First, Middle)
Business name (if any)
(Area code) Telephone number and extension
(Area code) Alternate telephone number
email address
Mailing address
City
State
ZIP code
Complaint summary
Provide a brief summary of your complaint. Attach an additional sheet if necessary.
The information I have provided above is true and correct, and I have provided all required enclosures to which I have access.
X
Signature
Date
We are committed to providing equal access to our services.
If you need accommodation, please call (360) 664-6597 or TTY (360) 664-0116.
BPD-600-006L (R/6/15)WA Page 1 of 2

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