Complaint Form Motor Vehicle

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State of Maine
WILLIAM J. SCHNEIDER,
Office of Attorney General
Attorney General
Consumer Protection Division
Consumer Mediation Service
Complaint #
6 State House Station
Augusta, ME 04333-0006
Mediator
COMPLAINT FORM
PDF
MOTOR VEHICLE
Please answer the questions below as completely as possible and include copies of your bills, contracts, estimates, receipts,
warranty, advertisements, etc. Do not send originals. Please print neatly or type. Please do not use staples.
Name Of Business Complaint Is To Be Filed Against
Name of Consumer
Name of
Your
Business: ________________________________________
Name: _____________________________________________
Address: ________________________________________
Address:____________________________________________
City: ___________________ State: _____ Zip: _________
City:______________________ State:______ Zip: __________
Tel: ___________________________________________
Tel: Work _________________ Home ___________________
Fax: ___________________________________________
Cell: _____________________Fax:_____________________
Email:
Email:
Manufacturer
My complaint involves
:
Name of
New vehicle:_____
Make:______________________
Manufacturer:____________________________________
Used vehicle:_____
Model:_____________________
Leased vehicle:_____
Year:_______________________
Address: ________________________________________
Rental vehicle:_____
Vin:________________________
Repairs:_____
Mileage at purchase:___________
City: ___________________ State: _____ Zip: _________
Other:_____
Current mileage:______________
Date Problem Occurred: _________________________________
Tel: ___________________________________________
_
Fax: ___________________________________________
Email:
Date of Transaction:_____________
Price:______________ Name of Person you dealt with:__________________________
Was the service or product advertised?
Yes___
No___
If yes, was the advertisement accurate?
Yes___ No___
Did you sign a contract? Yes___ No___
Did you buy an extended warranty or service contract? Yes___ No___
Did you receive a warranty?
Yes___ No___ Describe the warranty _____________________________________________
_____________________________________________________________________________________________________
Did you pay a document fee? Yes__ No__ Was the amount posted on the vehicle? Yes__ No__ Amount posted was $______
USED VEHICLE:
Did the dealer display the following stickers on the car?
Valid Inspection Sticker:
Yes ___ No ___
If yes, give expiration date: ___________________________
Unsafe Motor Vehicle Sticker: Yes ___ No ___
Used Vehicle Buyer’s Guide: Yes ___ No ___
Did you receive a copy of the Used Vehicle Buyer’s Guide? Yes ___ No ___
Did the Buyer’s Guide accurately describe all serious damage or repairs? Yes ___ No ___
Could the vehicle pass the state inspection when it was sold to you? Yes ___ No ___
REPAIR OF VEHICLE:
Date(s) of repair: __________________________________
Number of days in the garage for repair: _________________
Number of times repaired for the same problem _______________________________________________________________
Did you receive a written estimate? ________. Did you leave a written limit for the cost of the repair? _________
Final repair cost:_______________________________
Dollar amount of estimate:____________________________
PLEASE COMPLETE NEXT PAGE

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