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Today is:
Complaint
MISSISSIPPI MOTOR VEHICLE COMMISSION
COMPLAINT FORM
This is the official form for filing a complaint with the Mississippi Motor Vehicle Commission.
The nature of the complaint should be clearly and thoroughly stated.
* Required Fields
Complainant Information:
*
Name:
*
Address:
*
City, State Zip:
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Washington
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Wyoming
*
Work Phone:
*
Home Phone:
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Email:
Mailing (If Different)
Address:
City, State Zip:
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Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Washington, DC
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Dealer Information
License No.
*
Dealership Name:
Owner/Manager:
*
Dealership Address:
*
City, State Zip:
Select
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Washington, DC
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
*
Business Phone:
Name of Person With Whom You Dealt:
Vehicle Purchased:
Model (Year/Type):
Purchased:
New
Used
Manufacturer:
VIN Number:
Date of Purchase:
Amount Paid:
Amount Financed:
Date Of Your Last Contact With Business:
With Whom Did You Speak?
His/Her Title?
Do you know of others with similar complaints against this company?
Name 1:
Contact Address:
City:
State:
Select
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Washington, DC
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Zip:
Name 2:
Contact Address:
City:
State:
Select
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Washington, DC
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Zip:
*
Summary of Complaint (
Briefly describe your complaint. Include specific dates.
):
Uploaded Documentation:
Electronic/Scanned documentation may be added on the next screen.
*
Have you retained a private attorney regarding this matter?
Yes
No