Complaint Form Motor Vehicle (Page 2 of 2) in pdf

Complaint Form Motor Vehicle Page 2

Please summarize your complaint in the space below. This complaint petition will be the only document

we forward to any interested parties. Describe any promises the business made and whether those promises

were kept. You may send in additional and more detailed materials and statements to assist us in our

mediation effort, but please keep them separate from this complaint.

How did the business respond to your complaint?

What do you believe would be a fair resolution of your specific complaint?

Have you submitted this matter to another agency or lawyer?

Yes ____

No ____

Agency’s or lawyer’s name and phone:

Have you sued the company or has the company sued you?

Yes ____

No ____

May we send a copy of this complaint to the business?

Yes ____

No ____

If you check “no” we will not be able to mediate your complaint.

However, we will keep your complaint in our files.

Please indicate which age category applies to you (statistical purposes only):

Under 18( )

18-29( )

30-39( )

40-49( )

50-59( )

60-69( )

70-79( )

80-89( )

90 plus( )

This complaint form is valid only when accompanied by a letter from the Office of Attorney General.

Complaint Form Motor Vehicle Page 2