Customer Feedback Form


If you would like to provide us with feedback or have a concern you would like to raise with us about an experience you have had with Chemical Bank, please complete the Customer Feedback form below. Your feedback will be submitted to the appropriate department and you will hear back from us within 10 business days.

Customer Information

Prefix:
First Name:
Last Name:
Address:
Address 1:
City:
State:
Zip Code:
Home Phone (xxx-xxx-xxxx):
Cell Phone (xxx-xxx-xxxx):
Work Phone (xxx-xxx-xxxx):
Email Address:
I am:  
 
Preferred Method of Contact:
Preferred Contact Time:

Reason for Feedback

Product or Service Involved:

Please explain the circumstances in regards to this feedback:

Place of transaction (if applicable):
Date of transaction (if applicable):
Transaction amount (if applicable):
Select one that best applies to this Feedback: