NSDA Difficult Transaction Form

Please check applicable box below

Dealer to Dealer

CustomertoDealer

Dealer to Customer

Name of Filer;

Address of Filer:

City of Filer:

State

Country

Date of transaction: mm/dd/year

Please give us in the area below the Name, Address, Phone/Fax

email and any other information on the person or company you are having

difficulties with.

Filers email:

Filers contact phone #:

Please provide us with the details of this complaint. Please be to the point.

We will most likely need supporting documentation of this complaint. Be

prepared to provide us with these for review. Examples: proof of mailing,

invoices, copies of any written or email communications you have about

this transaction.