Report Collections, Debt, and Lien Fraud Online Form

Please provide as much information as possible in the blanks below. You may remain anonymous if you wish.

Note: Anonymous complaints may not be able to be investigated.

* indicates required field

Name

Address

City

State

ZIP

Phone

E-Mail

Other Identifiers

(SSN, DOB)

Violator's Name

Violator's Address

Violator's City

Violator's State

Violator's Zip

Other Identifiers

(SSN, DOB)

Type of Violation

No Registration (business does not have a registration, illegal operation, certificate issues, etc.)

Debt/Lien Complaints

Describe your complaint

Violators Business Information

Provide information regarding violator's business or employees (names, how they earn income, do they hide income, etc.)

File Attachment

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