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Consumer Complaint

SECTION 1: Your Information
Last Name *
First Name *
Mailing Address Line 1 *
Mailing Address Line 2
City *
State *
Zip Code *
Country, if not US
Day Phone *
Evening Phone
Mobile Phone *
Fax Number
County of Residence *
Email *
SECTION 2: Compliant Information (complete any that apply to your complaint)
Year *
Make *
Model *
Date of Reposession
SECTION 3: Information About The Transaction
Where did the transaction take place?
At my home At my workplace By Mail Over the phone Via computer (website or email) Trade show or hotel Other
If other, please describe below
SECTION 4: Details of The Complaint
Please explain your complaint in detail...
SECTION 5: Confirmation

I confirm that the information provided is true and accurate to the best of my knowledge.
Security Code: *
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