SafeClear

Complaint Form

 

The date and time of your complaint is automatically generated when you click SUBMIT.
   
Wrecker Company:
License Plate of Wrecker:
Wrecker Driver's Name:
Time of Incicent :
Location Hundred Block: (REQUIRED)
Freeway Location: (REQUIRED)
Did you receive a SafeClear Bill of Rights?
.
What was the reason for the interaction between you and the wrecker?
. (REQUIRED)
Service Provided (REQUIRED):
Were you charged for the services?
.
If you answered YES, how much were you charged?:
Nature of Complaint (REQUIRED):
Your Name (REQUIRED) :
Your Phone Number: (REQUIRED)
Your License Plate #:
Your License Plate State.
Your E-Mail (REQUIRED):