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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.

Complaint Information
*Denotes required fields. Form will be rejected if the information is not complete.
*(8000 characters allowed)

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Complaint Information

Investment Information 


Payment was made by      
Date of Investment(s):
Did you receive a prospectus or other information regarding the financial condition of the company? Yes   No  
Did the seller give you information that later turned out to be untrue? Yes   No  
Yes   No  
Have you contacted an attorney or any other government agency? Yes   No  
Have you asked for the return of your initial investment?  Yes    No  

If so, did you receive it?  Yes    No  

Investor Information 
Date Of Birth
Digital Signature 

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

*I agree that the information provided is accurate to the best of my knowledge and wish to provide a Digital Signature to my complaint.



When sending your supporting documentation be sure to include your Reference ID, which is displayed above and appears at the top right of your printed complaint.  The documents listed below are examples of documentation that will aid the Securities Division in the review of your complaint.

Stock certificates/bonds/investment certificates
Confirmations of purchases
Cancelled checks (front and back)
Any other documentation or advertising relating to the investment

Please mail all correspondence to:

Office of the Secretary of State
Securities Division
Attention — Complaints
PO Box 1276
600 W.Main St.
Jefferson City, MO 65102


Please be advised that the Securities Division, the Commissioner of Securities, the Secretary of State, and all employees thereof, are prohibited by law from giving you legal advice, legal opinions, or acting as your attorney.  You may wish to consult with a private attorney to discuss your legal rights and remedies.