Division of Financial Services Complaint Form | DORA

Instructions:
Please complete this form for complaints related to a Colorado state-chartered credit unions, savings and loan associations, or life care institutions.

Complainant Information

Individual Name

Additional Complainants (if applicable)

Business Name (if applicable)

Street Address

City/Town

State/Province

ZIP/Postal Code

Mailing Address (if different)

City/Town

State/Province

ZIP/Postal Code

Primary Phone Number

Alternate/Cell Phone Number

E-mail Address

Institution Information

Please select an institution from one of the lists below. Please note, if your institution is not listed below, we may not be able to process your request.

Financial Institution (FI) Name

Life Care Institution Name

Institution Contact

Institution Contact Name/Title

Institution Contact Email

Institution Contact Phone

Complaint Details

Date(s) of Disputed Transaction

Disputed Amount

Description of Complaint

Proposed Resolution

Upload Supporting Documents/Attachments (Limit of 5 files)

Upload requirements