State of Mississippi Motor Vehicle Commission
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  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:
 * Work Phone:
 * Home Phone:
     
Mailing (If Different)
  Address:
  City, State Zip:



   


Dealer Information
  License No.
 * Dealership Name:
  Owner/Manager:
 * Dealership Address:
 * City, State Zip:
 * Business Phone:
     

Name of Person With Whom You Dealt: 
Vehicle Purchased:
Model (Year/Type):
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:
    Zip:
       
Name 2: Contact Address:
    City:
    State:
    Zip:
       


*Summary of Complaint (Briefly describe your complaint. Include specific dates.):



   
Uploaded Documentation:
Electronic/Scanned documentation must be added from the complaint update screen.
 
   
*Have you retained a private attorney regarding this matter?

   
   

State of Mississippi Motor Vehicle Commission
1755 Lelia Drive, Suite 200
Jackson, MS 39216
601-987-3995
Fax: 601-987-3997
Transparency Mississippi Management and Reporting System

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