Online Complaint Form – Louisiana Used Motor Vehicle Commission

First Name *

Last Name

Home Address:

Address *

Address Line 2

City *

State *

Zip Code *

Mailing Address: (If different from Home)

Address

Address Line 2

City

State

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 *

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? *

If other, describe:

Briefly state the facts of your complaint. Include specific names, dates, and other information relative to your complaint. *

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

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