Ombuds Request

(* Denotes Required Fields)

Complainant Information
Name of Complainant: (required)
Firm:
Address: (required)
Email: (required)
Preferred Phone for contact: (required)
Best time to contact you:
Role in Transaction: (required)
Subject property (if any):
Respondent Information
Name of Respondent: (required)
Firm: (required)
Address: (required)
Email:
Phone: (required)
Role in Transaction: (required)
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: (required)
[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.