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DIRECTIONS:
Please complete the following questions with as much detail as possible. This allows our staff to gather and analyze the most pertinent information in assessing your complaint and a possible enforcement action.
Investor Information

*Denotes required fields. Form will be rejected if the information is not complete.

Complaint Information

*The Company Name or the Representative fields are required.

*
Investment Information
Did the seller give you information that later turned out to be untrue?
Did you sign a contract?
Have you contacted an attorney or any other government agency?
If yes, who?
Have you asked for the return of your initial investment?
If so, did you receive the return of your initial investment?
*I agree that the information provided is accurate to the best of my knowledge, and I wish to provide a digital signature to my complaint.