Online Complaint Form

Online Complaint Form








    
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  Home Address:

    Address
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    Address Line 2
        
    
    
    
    


    City
        *
    
    
    
    


    State
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		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
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    Model
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    Year
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Was this vehicle financed: 
        *
    
    
		
			
			 Yes
		
			
			 No

    
    


    If yes, by whom:
        
    
    
    
    





    
Type of warranty
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			 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?
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			 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.

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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
        
    
    

    
    



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