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Complaint Submission Form
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Complaint Submission Form
Complaint Form
For internal use only. Form used for logging complaints.
Date of Complaint:
MM slash DD slash YYYY
Name of Employee Submitting Complaint:
First
Last
Complainant Name:
First
Last
Account number: (if applicable)
Complaint Type:
Loan servicing issue
Customer service issue - deposit
Customer service issue - loan
Overdraft fees
Other deposit related fees
Loan fees
Deposit interest rates
Loan interest rates
Other
Please provide details of the complaint:
Should this matter be escalated?
*
No
Yes
Person or department the matter should be escalated to?
Has the matter been resolved?
*
No
Yes
Provide details of resolution:
Email
This field is for validation purposes and should be left unchanged.
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