Customer Complaint Form
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3OMB Control No. 1557-0232
Expiration Date: 12/31/2008
O
Comptroller of the Currency
Administrator of National Banks
CUSTOMER COMPLAINT FORM
Please fill in this form completely, including your signature at the end of the form. If a valid OMB Control
Number does not appear on this form, you are not required to complete this form. The Office of the
Comptroller of the Currency (OCC) will only act on complaints that are signed by the complainant(s), legal
guardian, attorney of complainant(s) along with their client’s authorization, or holder of power of attorney.
Include copies of documents related to your complaint such as contracts, monthly statements, receipts
and correspondence with the bank.
Mail or fax this completed complaint form with any attachments to:
Office of the Comptroller of the Currency
Customer Assistance Group
1301 McKinney Street, Suite 3450
Houston, TX 77010-9050
1-713-336-4301 (Fax)
In filling out this form, print or type clearly so the information can be easily read and understood.
Customer Information:
Mr.
Ms.
Mrs.
Miss
Name:
First
Middle
Last
Address:
Street
City
State
Zip
Daytime Phone:
(
)
Fax:
(
)
Email:
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Parent category: Legal