Ombuds Request

(* Denotes Required Fields)

Complainant Information
Name of Complainant: *
Firm:
Address: *
Email: *
Preferred Phone for contact: *
Best time to contact you:
Role in Transaction: *	Buyer Seller Agent Broker Other
Subject property (if any):
Respondent Information
Name of Respondent: *
Firm: *
Address: *
Email:
Phone: *
Role in Transaction: *	Listing Agent Selling Agent Broker Other
Broker Lookup
Name of Respondent's Broker:
Broker's Email:
Broker's Phone:
What issue would you like the Ombuds to resolve?
Explain the issue: *
[OPTIONAL] By checking the box below, I agree I am willing to participate in Voluntary Mediation to attempt to resolve a dispute. I understand Mediations are voluntary for both parties to participate in and there is no cost to participate. Learn more about the mediation process.
Check here to agree:	I understand and would like to try voluntary mediation
All information on this form is confidential.
The Connecticut REALTORS® will destroy this form and any other documents and materials pertaining to this matter at the conclusion of the Ombuds services.