Complaints

Consumer's Contact Information

Title

First Name*

Middle Name

Last Name*

Mailing Address*

City*

State*

9-Digit Zip Code*

Home Phone*

Business Phone*

Email*

Fax

Filing for a third party?

Yes

We can accept complaints from third parties on behalf of consumers only in limited circumstances. If you are filing on behalf of another person, please give your contact information.

Title

First Name*

Middle Name

Last Name*

Mailing Address*

City*

State*

9-Digit Zip Code*

Phone*

Email*

Relationship to Consumer*

Information About the Branch

Name*

Mailing Address*

City*

State*

9-Digit Zip Code*

Phone*

Web Address

Dates you complained to the branch*

Name(s) and title(s) of of individuals at branch with whom you dealt*

Specifics of your dispute or complaint

Product/Service*

Date of Occurrence*

Total Cost*

Amount Paid*

Property Address*

File #*

If applicable, who coordinated/closed the transaction?

If applicable, who did you speak with concerning any title issues?

Please describe the complaint briefly but with enough details to make the situation clear

If needed, attach additional pages?

Yes

File

What form of relief has been requested, or what would you consider a satisfactory resolution to the situation?*

Have you contacted a government agency regarding this issue?

Yes
No

If yes, Agency name and contact person

Have you hired a private attorney?

Yes
No

If yes, Attorney's name/phone number

Disclaimer

In providing this form, I understand that ATA National Title Group is attempting to mediate my complaint. I also understand that if I have any questions concerning my legal rights or responsibilities, I should contact a private attorney. I have no objection to the contents of this complaint being forwarded to the person the complaint is directed against. The above complaint is true and accurate to the best of my knowledge.

Yes, I understand*

Yes, I understand

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Email

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Contact and Advice

Consumer's Contact Information

Information About the Branch

Specifics of your dispute or complaint

Disclaimer