Form Vs-35 - Complaint Report - Page 2
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2C. Vehicle Purchase Complaint
Attach a copy of your Bill of Sale and/or Certificate of Sale.
1. Were any vehicle components in need of repair or adjustment?
Yes
No
If Yes, which components?
____________________
____________________________________________________________________________________________________________
2. Have you gone back to the dealer for repairs or adjustments?
Yes
No
If No, would you go back if the dealer offered to make
repairs or adjustments?
Yes
No
3. Was a Temporary Certificate of Registration issued?
Yes
No
If yes, what is the facility number written on the temporary
registration? ___________________________
/
/
4. Inspection Certificate # _________________________
Expiration Date _________________________
NOTE: If a repair or diagnosis of the vehicle was made, complete Section A on the front of this form.
D.
If there is additional information that will help us to evaluate your complaint, please include this information below or use an additional
sheet of paper..
E.
What do you want done to resolve this complaint to your satisfaction?
Are you willing to appear and testify at a hearing if one is held to resolve this complaint?
Yes
No
Be sure to attach COPIES of any supporting correspondence and/or documents such as receipts, invoices, written estimates, written
guarantees or warranties, cancelled checks or credit card transaction forms.
Sign below and mail this complaint form with all necessary attachments to: BUREAU OF CONSUMER & FACILITY SERVICES, PO BOX 2700-
ESP, ALBANY NY 12220-0700. Phone #: (518) 474-8943
Fax:(518) 486-4102
I understand that a copy of this form and any or all of the enclosed information may be sent to the facility shown on the front of this form. All
information provided in this complaint is true and factual.
±
________________________________________________
_______________________
(Signature)
(Date)
reset/clear
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VS-35 (3/11)
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