Consumer Complaint Form
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2FR 1379c - OMB No. 7100-0135
Approval expires August 31, 2019
Please print clearly below.
Mail or fax this completed form to:
Federal Reserve Consumer Help
PO Box 1200, Minneapolis, MN 55480
Fax: 877-888-2520
CONSUMER COMPLAINT FORM
Questions? Call us at 888-851-1920
*Required Fields
YOUR INFORMATION
Pre x:
Mr.
Mrs.
Ms.
Dr.
*First Name:
*Last Name:
*Address:
City
State
Zip Code
Country
E-mail:
*Phone:
Alternate Phone:
*Contact Preference:
Mail
E-Mail
REPRESENTATIVE CONTACT
Do you want us to communicate with a third party, such as an attorney or other legal representative, regarding this complaint?
Yes
No
If you checked ‘No’ , skip to Institution Information.
By selecting ‘Yes’ , you legally authorize the Federal Reserve System to release information to and communicate directly with
the party named below and for that party to act on your behalf in the processing of this complaint.
Ms.
Dr.
Pre x:
Mr.
Mrs.
*First Name:
*Last Name:
*Address:
City
State
Zip Code
Country
E-mail:
*Phone:
Alternate Phone:
INSTITUTION INFORMATION
Please provide as much information as possible about the bank or nancial institution.
*Institution Name:
Account / Product Type:
Routing Number:
*Address:
City
State
Zip Code
Country
If you do not have the exact address of the bank or nancial institution, provide a location, such as the nearest cross streets
or major intersection.
E-mail:
Phone:
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