Dealer Complaint

Select the option that best describes the entity filing the complaint and enter that entity's identification information.

Fields marked with an asterisk (*) are required.

This Complaint is being filed by:

an Individual

a licensed dealership

a business

Identification
Enter the contact information for the person filing the complaint.

Prefix		First Name *
Middle Name		Last Name *
Suffix		SD Identification #

Mailing Address
If the mailing address and the physical address are different uncheck Same as Mailing Address and fill in the physical address as well.

Street *

City, State, Zip Code & County *

Physical Address

Same as Mailing Address

Contact Information

Phone #	EX: 605-123-4567
Alternate Phone #
Fax #
Email