Ombudsman Request Form REALTOR® or Public

* Fields are required

Your Information

Name:*

Your Phone:*

Your Address:

Your Email:

Name:*

Firm Name:*

Phone:*

Email:*

Name:

Firm Name:

Phone:

Email:

Has a formal complaint been filed with the Long Island Board of REALTORS? *

Yes

Is this dispute involved in civil or criminal litigation? *

Yes

Has a formal complaint been filed with any other administrative or government agency? *

Yes

If yes, what agency?

Please briefly state the concerns that you would like to address with a Long Island Board of REALTORS Ombudsman: *