Ombudsman Request Form

Complainant's Information

Name of Complainant - First and Last
A copy of this form will be sent to this email address.
Preferred number for contact
Mailing Address
Street Address
Apartment/Suite # (Optional)
City
State
Zip
(ex: buyer, seller, agent, broker)

Respondent's Information

First and Last
Respondent's Address
Street Address
Apartment/Building/Suite # (Optional)
City
State
Zip
(ex: listing agent, selling agent, broker)
* All information on this form is confidential. The Medina County Board of REALTORS® will destroy this form and any other documents and materials pertaining to this matter at the conclusion of the ombudsman services.