NEVADA TRANSPORTATION AUTHORITY

PASSENGER TRANSPORTATION COMPLAINT FORM

PLEASE NOTE THE NTA DOES NOT HAVE JURISDICTION OVER INTERSTATE (FROM ONE STATE TO ANOTHER) PASSENGER TRANSPORTATION 

 

 

 

COMPLAINANT INFORMATION 

*NAME (LAST, FIRST, MI): 

ADDRESS: 

CITY  *STATE  

ZIP: 

*PHONE: 

CELL PHONE: 

ALTERNATE PHONE NUMBER: 

EMAIL ADDRESS: 


PASSENGER TRANSPORTATION COMPANY INFORMATION

*COMPANY NAME: 

COMPANY ADDRESS: 

CITY  *STATE  

ZIP: 

COMPANY'S PHONE: 

COMPANY'S WEBSITE (if available): 

PERSON(S) CONTACTED AT ABOVE COMPANY: 

DATE OF OCCURRENCE:   [None] Select a Date Delete the Date 

TIME OF OCCURRENCE: 

LOCATION OF OCCURRENCE: 

TRIP START ADDRESS:   

TRIP ENDING ADDRESS: 

NAME OF DRIVER: 

*PAYMENT MADE TO THE COMPANY?  


     IF SO, AMOUNT PAID: 

INVOICE/RECEIPT NUMBER: 


DETAILS OF COMPLAINT

  • PLEASE PROVIDE A DETAILED STATEMENT REGARDING YOUR COMPLAINT
AND THE NATURE OF THE RELIEF SOUGHT.

  • DO NOT OMIT ANY FACTS, AS ALL INFORMATION MAY BE RELEVANT TO OUR
INVESTIGATION.
  • EMAIL ANY DOCUMENTATION WHICH MAY SUPPORT YOUR CLAIM
(PHOTOS, INVOICES, ETC.) TO NTA@NTA.NV.GOV 
 
 
 
 


 

THE NEVADA TRANSPORTATION AUTHORITY (NTA) WILL NOT PROCESS ANY UNSIGNED, INCOMPLETE, OR ILLEGIBLE COMPLAINT FORMS

I understand that the NTA represents the public by ensuring that businesses licensed by their authority are in compliance with the laws related to NRS 706, 706A, & 712 and NAC 706 & 706A.  Pursuant to NAC 706.3974 and NAC 706A.420, your completed complaint form will be assigned to a Nevada Transportation Authority Investigator. The investigator will contact you to acknowledge receipt of your complaint within 15 days. Within 20 days of receiving a complaint, the investigator will provide a copy of the complaint to the respondent and request a response to the complaint. Pursuant to NAC 706.3975 and NAC 706A.430, the respondent has up to 15 days to respond to the request of the investigator. Pursuant to NAC 706.3976 and NAC 706A.440, the investigator will contact the complainant and the respondent to provide the results of the investigation.

 

I hereby affirm under penalty of perjury that I am an adult, 18 years of age or older, that I have personal knowledge of this matter stated herein, and that the assertions contained in this complaint are true.

 

Electronic Signature

                Date:   [None] Select a Date Delete the Date

Please type your First and Last Name


  I understand that checking this box constitutes a legal signature confirming that the information provided herein is true and accurate.


Note:  All fields with an asterisk (*) are required to be filled in prior to submitting the form