File A Complaint

Fill out the online complaint form below, or

Instructions:

Upon receipt of a properly completed Complaint Form, the Arkansas Securities Department (ASD) will review the complaint and, generally request a response from the company or individual that is the subject of the complaint. Based on this information, ASD will decide whether or not to begin a formal investigation. If a formal investigation begins, it will ordinarily remain confidential, as will any related documentation. You are invited to attach photocopies (no originals please) of supporting documents to the Complaint Form.

Please Check One:(Required)

Securities

Broker-dealer

Investment Adviser

Mortgage Company

Loan Officer

Money Transmitter

Currency Exchange

Please provide the following information about yourself:

Name(Required)

First Middle Initial Last

Address(Required)

Street Address City State ZIP Code

Daytime Phone(Required)

Evening Phone

Best time to call(Required)

Email(Required)

Please provide the following information about the company your compaint is against:

Company Name(Required)

Phone(Required)

Address(Required)

Street Address City State ZIP Code

Person you dealt with at the company:

Name(Required)

First Middle Initial Last

Please briefly describe your complaint below:(Required)

Please provide information regarding legal representation/action:

Is an attorney representing you in this matter?(Required)

If you have an attorney for this matter, may we contact your attorney?(Required)

Attorney Name(Required)

First Last

Law Firm Name(Required)

Phone(Required)

Address(Required)

City State ZIP Code

PLEASE READ BEFORE SIGNING:

By signing this Complaint Form I acknowledge that (1) the information I have provided is true to the best of my knowledge and belief, (2) I have read and understand the Notice in the paragraph below, and (3) I authorize the ASD to provide information from this Complaint Form to the company that is the subject of the complaint, or to use the information I have provided in any manner deemed necessary or proper by the ASD.

NOTICE:

The ASD does not provide personal legal advice, nor will it represent you in court proceedings. Also ASD cannot decide disputes, arbitrate claims or order firms to pay judgments in personal disputes. In order to recover lost funds or obtain comparable relief, you may have to initiate private legal action; prompt action on your part is critical because state and federal laws known as “Statutes of Limitations” impose strict time limits on filing law suits. Thus, you may wish to contact an attorney immediately. For names of attorneys in your area, call the Arkansas Bar Association or your local bar association.

Signature:(Required)

Date Signed:(Required)

File

Max. file size: 50 MB.

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(800) 981-4429

Vulnerable Adult Report

Instructions:

Please provide the following information about yourself:

Please provide the following information about the company your compaint is against:

Person you dealt with at the company:

Please provide information regarding legal representation/action:

PLEASE READ BEFORE SIGNING:

NOTICE: