Department Of Commerce and Insurance
Motor Vehicle Commission
500 James Robertson Parkway, 2nd Floor
Nashville, Tennessee 37243-1153
(615) 741-2711

Fax (615) 741-0651

 

Click here for printable version


On-Line Consumer Complaint Form
(* denotes required field)

Date Filed
*Complainant
*Mailing Address
*City
*State
*Zip
*Telephone Number
Email Address
Are you  licensed by this State Board? Yes No
If YES, give license Number
*Respondent(s)
*Street Address
*City
*State
*Zip
Telephone Number
Please provide the following information.
Make
               (Ford, GMC, etc.)
Year VIN
      (Vehicle Identification Number)
Date of Transaction Have you contacted the company about this complaint? Yes No
Name of the contact person at the respondent's business
Have you taken any private legal action on this complaint? Yes No
Was this product or service advertised ? Yes No
If yes, you will be asked to provide the ad.
How are you involved? Purchaser Co-signer Other


NOTE:
Pursuant to TCA Title 47, Chapter 18, the Tennessee Consumer Protection Act, you may want to file a complaint with the Division of Consumer Affairs, 5th Floor, 500 James Robertson Parkway, Nashville, Tennessee 37243. (615-741-4737) or (800-342-8385)

Form IN-0759 (Rev. 3/88)

 

*BASIS FOR YOUR COMPLAINT

Give a complete statement of the facts, with dates. You may also be asked to provide originals of all documents that will support your allegations. You should retain copies.

Other persons with firsthand knowledge of your complaint:

Name
Address
Mailing Address City State Zip
Home Phone Business Phone
Name
Address
Mailing Address City State Zip
Home Phone Business Phone
Have you consulted an attorney? Yes No
If YES, please provide the following:
Name
Address
Street Address City State Zip
Phone    
By submitting this information, I hereby attest to the accuracy or truthfulness of the content. I agree.

*Signature  (Please type your name)     *Date