Ground Transportation Complaint Form

Complete this form to file a complaint online, or download and mail the Ground Transportation Complaint Form to:

Transportation Division

Vehicles for Hire/Ground Transportation Section

P.O. Box 1088

Austin, TX 78767-1088

PERSON MAKING COMPLAINT

Name: *

Address (Line 1): *

Address (Line 2):

City: *

State: *

ZIP Code: *

Enter the five-digit ZIP code. (Example: 78701)

Home Phone Number: *

Enter the ten-digit phone number, including the area code. (Example: 123-456-7890)

Work Phone Number:

Enter the ten-digit phone number, including the area code. (Example: 123-456-7890)

E-mail: *

Enter your complete e-mail address, including the '@' symbol. (Example: name@example.com)

FILING COMPLAINT AGAINST

Provide as much information as possible.

Company Name:

Operator Name:

Type of Vehicle:

Taxi, limousine, etc.

Vehicle ID #:

Taxi #, license plate #, etc.

Description of Vehicle:

Make, model, year, color, etc.

WITNESS(ES)

Name:

Address (Line 1):

Address (Line 2):

City:

State:

ZIP Code:

Enter the five-digit ZIP code. (Example: 78701)

Home Phone Number:

Enter the ten-digit phone number, including the area code. (Example: 123-456-7890)

Work Phone Number:

Enter the ten-digit phone number, including the area code. (Example: 123-456-7890)

Name:

Address (Line 1):

Address (Line 2):

City:

State:

ZIP Code:

Enter the five-digit ZIP code. (Example: 78701)

Home Phone Number:

Enter the ten-digit phone number, including the area code. (Example: 123-456-7890)

Work Phone Number:

Enter the ten-digit phone number, including the area code. (Example: 123-456-7890)

DETAILS OF COMPLAINT

The following information is true and correct to the best of my knowledge and belief.

Date of Incident: *

Month

Day

Year

Time of Incident:

Description of Incident: *

SIGNATURE: *

Type your full name to verify signature and uphold that the preceding information is true and correct to the best of your knowledge and belief.

Leave this field blank

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