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Consumer Complaint

SECTION 1: Your Information

Title

Last Name *

First Name *

M.I.

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 *

VIN *

Mileage

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: *