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Dealer Complaint Form
November 13, 2024
Your Information
First Name
Last Name
Address 1
Address 2
City
State/Province
ALBERTA
ALASKA
ALABAMA
ARKANSAS
ARIZONA
BRITISH COLUMBIA
CALIFORNIA
COLORADO
CONNECTICUT
DISTRICT OF COLUMBIA
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FLORIDA
GEORGIA
HAWAII
IOWA
IDAHO
ILLINOIS
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KENTUCKY
LOUISIANA
MASSACHUSETTS
MANITOBA
MARYLAND
MAINE
MICHIGAN
MINNESOTA
MISSOURI
MISSISSIPPI
MONTANA
NEW BRUNSWICK
NORTH CAROLINA
NORTH DAKOTA
NEBRASKA
NEW FOUNDLAND
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NOVA SCOTIA
NORTHWEST TERRITORY
NEVADA
NEW YORK
OHIO
OKLAHOMA
ONTARIO
OREGON
PENNSYLVANIA
PRINCE EDWARD ISLAND
PUERTO RICO
PROVINCE OF QUEBEC
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
SASKATCHEWAN
TENNESSEE
TEXAS
UTAH
VIRGINIA
VERMONT
WASHINGTON
WISCONSIN
WEST VIRGINIA
WYOMING
YUKON TERRITORY
Kansas
Zip/Postal Code
Email
Daytime Phone Number
Dealer Information
Dealership Name
Name of person at dealership you dealt with
Place of Transaction
Transaction Date
Address 1
Address 2
City
State/Province
ALBERTA
ALASKA
ALABAMA
ARKANSAS
ARIZONA
BRITISH COLUMBIA
CALIFORNIA
COLORADO
CONNECTICUT
DISTRICT OF COLUMBIA
DELAWARE
FLORIDA
GEORGIA
HAWAII
IOWA
IDAHO
ILLINOIS
INDIANA
KENTUCKY
LOUISIANA
MASSACHUSETTS
MANITOBA
MARYLAND
MAINE
MICHIGAN
MINNESOTA
MISSOURI
MISSISSIPPI
MONTANA
NEW BRUNSWICK
NORTH CAROLINA
NORTH DAKOTA
NEBRASKA
NEW FOUNDLAND
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NOVA SCOTIA
NORTHWEST TERRITORY
NEVADA
NEW YORK
OHIO
OKLAHOMA
ONTARIO
OREGON
PENNSYLVANIA
PRINCE EDWARD ISLAND
PUERTO RICO
PROVINCE OF QUEBEC
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
SASKATCHEWAN
TENNESSEE
TEXAS
UTAH
VIRGINIA
VERMONT
WASHINGTON
WISCONSIN
WEST VIRGINIA
WYOMING
YUKON TERRITORY
Kansas
Zip/Postal Code
Vehicle Information
VIN
Year
Vehicle Make
Vehicle Model
Check if you have filed a complaint with any other agency
Name of Agency
Results or Status
Check if you hired an attorney to assist you in this matter
Name of Attorney
Address 1
Address 2
City
State/Province
ALBERTA
ALASKA
ALABAMA
ARKANSAS
ARIZONA
BRITISH COLUMBIA
CALIFORNIA
COLORADO
CONNECTICUT
DISTRICT OF COLUMBIA
DELAWARE
FLORIDA
GEORGIA
HAWAII
IOWA
IDAHO
ILLINOIS
INDIANA
KENTUCKY
LOUISIANA
MASSACHUSETTS
MANITOBA
MARYLAND
MAINE
MICHIGAN
MINNESOTA
MISSOURI
MISSISSIPPI
MONTANA
NEW BRUNSWICK
NORTH CAROLINA
NORTH DAKOTA
NEBRASKA
NEW FOUNDLAND
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NOVA SCOTIA
NORTHWEST TERRITORY
NEVADA
NEW YORK
OHIO
OKLAHOMA
ONTARIO
OREGON
PENNSYLVANIA
PRINCE EDWARD ISLAND
PUERTO RICO
PROVINCE OF QUEBEC
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
SASKATCHEWAN
TENNESSEE
TEXAS
UTAH
VIRGINIA
VERMONT
WASHINGTON
WISCONSIN
WEST VIRGINIA
WYOMING
YUKON TERRITORY
Kansas
Zip/Postal Code
Phone number
Check if you have filed any kind of lawsuit for this matter
Date filed
Name of Court
Describe your complaint
Attach any supporting documents here; must be in PDF format
By selecting agree, you are electronically signing this complaint form and agreeing to the following statement: This is a formal complaint to the Kansas Department of Revenue, Division of Vehicles, Vehicle Dealer Licensing Bureau. As such, the information provided below will be used to conduct investigative efforts deemed necessary and sufficient by the Department for enforcement of the Kansas Vehicle Dealer & Manufacturer Licensing Act, K.S.A. 8-2401, et seq. The complaining party is providing this information for the express purpose of enabling the department to fulfill its statutory enforcement duties. If the result of any investigation conducted following this complaint determines violations, the licensee (dealer) found in violation, following an opportunity for administrative hearing in accordance with K.S.A. 8-2411, may be subject to fines from $50.00 to $1,000.00 or suspension, revocation or non-renewal of license or both. The Kansas Department of Revenue, Division of Vehicles, though, does not have the authority to order a dealer to deliver title to a purchaser, return to a vehicle purchaser any of the purchase price of a vehicle or perform any specific act in conjunction with a sale or service transaction with a customer.*
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