Business Licensing Services Customer Complaint Form
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1
2Business Licensing Services Bureau
P.O. Box 170
New Jersey
Trenton, New Jersey 08666-0170
(609) 984-1122 (Office)
(609) 341-3314 (Fax)
Motor Vehicle Commission
mvcblsinvestigations@mvc.nj.gov
STATE OF NEW JERSEY
Business Licensing Services
Customer Complaint Form
COMPLAINT REPORTED BY:
COMPLAINT REPORTED AGAINST:
Name:______________________________________________________________
Business Name:_____________________________________________________
Address: ___________________________________________________________
Address: ___________________________________________________________
City: ______________________________________________________________
City: ______________________________________________________________
State: _______________________________________________ Zip: ________
State: _________________________________________Zip: _____________
Home Telephone Number:____________________________________________
Telephone Number:__________________________________________________
Cell Telephone Number: _____________________________________________
At a minimum, you must provide the business location or print the location of
Work Telephone Number:___________________________________________
where the purchase transaction occurred:
E-Mail Address: ____________________________________________________
*Note: By providing your e-mail address, you agree to receive communication from this office by e-mail
Nature of complaint (
1.
Please check the appropriate box(es)):
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Auto Body Repair Facility
Driving School
Limousine Company
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BAIID Installer
Inspection Facility
Remedial Driver Education Program
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Dealership
License Leasing Company
Window Tinting Company
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Other: Specify _____________________________________________________________
If your complaint involves the purchase of a motor vehicle, please provide the following information:
2.
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a.
New
Used
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b.
Purchased in Full
Financed
Leased
c.
Date of Purchase: _____________________
Current Mileage: ____________________
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d.
Purchase: Price: _______________________
With Warranty
With Service Contract
As Is
e.
Year: _____________
Make: _________________________________
Model: ________________________________
Name and title of employees you dealt with:
3.
Name: __________________________________________
Title: ______________________
Name: __________________________________________
Title: ______________________
Name: __________________________________________
Title: ______________________
On the Road to Excellence
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New Jersey is an Equal Opportunity Employer
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