Fraud/ID Theft Complaint/Report
Please fill out the items below so we can assist you.
If you have wired money to a scammer, it is important that we act quickly. Please go to reportwirefraud@state.co.us to report INSTEAD of filling out this form.
In order to insure a quick response, please fill our ALL pertinent information and make sure the information is accurate.
If you are simply reporting and DO NOT need a contact please check below.
Today's Date
MM
/
DD
/
YYYY
Full Name *
Your answer
Address
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone- Please fill in with the dashes *
Your answer
Email Address (Please fill in correct email if available. Otherwise fill in Phone above)
Your answer
I want to report: *
Explain what happened
Your answer
What have you done in response?
Your answer
Have you reported this to local law enforcement?
If you have reported to law enforcement please include Law Enforcement Agency, who you spoke to and case number, if available. If Law Enforcement declined to help, please explain.
Your answer
Have you contacted your financial institution? (If applicable)
If you have contacted your financial institution, please provide name of institution, phone number and who you spoke to.
Your answer
It is important that all information on this form is accurate so that we are able to best assist you. Thank you.
To speak with someone immediately, please contact our 24 Hour ID Theft & Fraud Hotline 1-855-443-3489 (toll free)
Submit
Never submit passwords through Google Forms.
This form was created inside of State.co.us Executive Branch. Report Abuse - Terms of Service