Printable Complaint Form. Use our complaint checker to answer a few questions about your complaint, what has happened and the financial business you want to complain about.We will forward your complaint directly to this company and ask for a response. Fill out the Online Customer Complaint Form. File a verified petition with notice of petition, or order to show cause in the Supreme Court. Learn where to file a complaint about banking and investment products, retirement plans, and the companies and professionals that offer them. 1. Name of the Complainant: Full name of the individual filing the complaint. Find out how we deal with complaints where consumers dispute the amount of, or having made, a transaction. Administers a large residential facility in the Southeast Region of Pennsylvania. Stacey Keilman, CEO Torrance State Hospital P.O. Box 111, Torrance, PA 15779.