File a Complaint

You can use the online form below to send your complaint to the International Securities Trade Agency. You can also print (and reproduce) this form and send it us by mail or fax. Please answer every question completely. You may want to write your answers on a separate sheet first, and then enter them in the fields on this form. When finished filling out the form, click on the Submit button at the bottom of this page. Your complaint will be sent to the International Securities Trade Agency.

Your Information

Complete Name:

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Street Address:

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Email Address:

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City

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State

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Zip

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Telephone (Day):

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Telephone (Night):

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Best Time to Call:

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Occupation:

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Complaint Against

Company Name:

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Person you dealt with:

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Street Address:

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City

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State

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Zip

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Telephone:

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Email or Website Address:

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Have you contacted the person or company about your complaint?

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No

If you answered yes, please describe:

Describe your complaint with the Company in detail:

If any, how much money did you invest or pay and how was it delivered?

Have you contacted another regulator or taken legal action?

Yes

No

If you answered yes, please describe:

Declaration By filling in my name and the date below, I declare that the information contained in this complaint is true and accurate and the information may be used to further investigate the complaint.

Name:

Date:

Agree to terms and conditions

You must agree before submitting.

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