Online Complaint Form * * Home Address: Address * Address Line 2 City * State * AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Mailing Address: (If different from Home) Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Home Phone * Mobile Phone Email Address * Dealership or Person your complaint is against: Name * Dealership name or First and Last name of Person Address * Address Line 2 City * State * AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Name and Title of person with whom you dealt: * First and Last name of Person Name * Title of Person Please fill in this section completely. Date of Purchase * VIN # * (17 Characters) Make of Vehicle * Model * Year * Was this vehicle financed: * Yes No If yes, by whom: Type of warranty * As Is / No Warranty Extended Warranty Other If other, describe: Did you receive a warranty or disclaimer, separate to the purchase agreement? * Yes No Did you receive the title? * Yes No If no, state the reason: Did you sign and receive a copy of the Federal Trade Commission Buyer’s Guide? * Yes No Did you sign and receive a copy of the Federal Odometer Statement? * Yes No Have you contacted the Owner/Manager about the problem? * Yes No If so, what was the outcome? How do you want this complaint resolved? * Refund Repair Replace / Trade Vehicle Need Title Need License Plate / Registration Other If other, describe: Briefly state the facts of your complaint. Include specific names, dates, and other information relative to your complaint. * Please attach copies of any relevant documents such as letters, bill of sale, contracts, warranties, advertisements, work orders, bills, etc. Please ensure that any uploaded documents do not exceed 25MB in size. We accept the following filetypes: jpg, gif, png, jpeg, pdf, doc, docx, xml, txt, xls, xlsx, zip, rar, and ace. If you are submitting images, please ensure that the maximum size does not exceed max-width: 2400 and max-height: 5000. Rcwd Upload Drag me 1 Drag your file here Remove File: Size: x Browse Upload + - Size: THERE IS NO FEE FOR THE ARBITRATION OF COMPLAINTS THROUGH THIS AGENCY. I am filing this complaint to notify your office of the activities of this party or parties and for any other assistance you may be able to render. I swear that the information contained herein is true and accurate to the best of my knowledge, information and belief. Please type your name to sign the form. Text * Complainant's Signature Text * Date Captcha Rcwd Upload Drag me Drag your file here Remove File: Size: x Browse Upload Size: Submit If you are human, leave this field blank.
Home Address:
Mailing Address: (If different from Home)
Dealership or Person your complaint is against:
Please fill in this section completely.
Please attach copies of any relevant documents such as letters, bill of sale, contracts, warranties, advertisements, work orders, bills, etc. Please ensure that any uploaded documents do not exceed 25MB in size. We accept the following filetypes: jpg, gif, png, jpeg, pdf, doc, docx, xml, txt, xls, xlsx, zip, rar, and ace. If you are submitting images, please ensure that the maximum size does not exceed max-width: 2400 and max-height: 5000.
THERE IS NO FEE FOR THE ARBITRATION OF COMPLAINTS THROUGH THIS AGENCY. I am filing this complaint to notify your office of the activities of this party or parties and for any other assistance you may be able to render. I swear that the information contained herein is true and accurate to the best of my knowledge, information and belief.
Please type your name to sign the form.