State of Maine Office of Securities Confidential Complaint Form

Required fields*

Investor Information
First Name*
Middle
Last Name*
Street Address
City*
State*
Zip*
Telephone (Daytime)*	--
Telephone (Evening)	--
Fax Number	--
Email Address*
Who is the complaint against?
Firm name
Street Address
City
State
Zip
Telephone	--
Full name of salesperson, agent or other representative
First Name
Middle
Last Name
Please provide us with the details of your complaint. Please be as specific as possible.*

The information you provide will be deemed confidential and neither the content nor the source of the information will be available for public inspection unless you consent to its release, the Office of Securities receives a subpoena or the Office of Securities institutes formal proceedings.