Auto Repair Complaint Form

If you would prefer to file your complaint by mail, click here for instructions for using our printed complaint forms.
Please capitalize the first letter of the consumer's name and address and the business's name and address.
Please complete the following information about the consumer involved in the dispute.
* Denotes Required Fields

Last Name:

*First Name:
*Prefix (e.g. Mr., Mrs., Ms., Miss):
Address 2 (if necessary):
*Zip Code:
*Best Telephone Number To Use During the Day:
Alternate Telephone Number :
E-mail Address:
Please enter only the primary e-mail address at which you would like us to contact you. Please type your address carefully with no extra spaces or characters. An incorrect e-mail address may delay action on your complaint.
If someone other than the consumer should be contacted about this complaint, please provide the name and telephone number for the contact person:
How did you hear about our office?


*Name of the Auto Repair Facility (or Dealership) involved in this dispute:
*Address (Please note: in order to assist you, it is important for us to have the full address of the repair facility or auto dealership. If you are not able to provide the address, please write "unknown"):
Address 2 (if necessary):
*Zip Code:
*Primary Telephone Number (Please note: in order to assist you, it is important for us to have the phone number of the repair facility or auto dealership. If you are not able to provide this phone number, please write "unknown"):
Alternate Telephone Number:
Fax Number:
E-Mail Address:
Web Site Address:
How did you hear about this facility?


*Name of the Manufacturer of the Vehicle:

*Model of the Vehicle:
*Model Year of the Vehicle:
VIN (Vehicle Identification Number):


Dates of Repair (Please list in chronological order):
Cost of Repair:
*Mileage on the Vehicle when Initially Repaired:
*Current Mileage on the Vehicle:
*Briefly describe the dispute you are having with the auto repair facility:
*What would you like the business to do to resolve your complaint?
If "Other", please describe:
If "make a refund", please state the amount desired:$


*Have you contacted the repair facility about your complaint? noyes
If yes, on what date(s)?
Name of the person to whom you complained:
What, if any, response have you received from the Repair Facility?
Has the Repair Facility suggested submitting your dispute to its arbitration program? noyes
Have you agreed to submit the dispute to the suggested arbitration program? noyes
Have you filed a complaint with any other government agency?noyes
If yes, which agency?
Have you contacted an attorney or filed a lawsuit in this matter?noyes

Please note that while you may file a complaint for informational purposes with this office in additional to filing a lawsuit, we cannot represent you or provide legal advice on your lawsuit.


*1. Please list all documents that support your complaint (such as repair invoices) and send us a copy of those documents, (no originals) along with a copy of this complaint form (all pages please):
2. Review the information you have provided above and make any needed corrections.
3. Click the Submit button below.
4. Print two copies of the Confirmation page.
5. Mail a copy of the Confirmation page (all pages please) along with any supporting documents.
Please note: It is important for us to have copies of all relevant documents to properly handle your complaint. Once we receive these documents, we will proceed with processing your complaint.
* Denotes Required Fields

If you experience a problem while trying to submit your complaint, you may contact our office at 410-528-8662, Monday through Friday from 9:00 a.m. to 3:00 p.m. or send an e-mail describing the problem to: You will receive a response during regular business hours.