NTA TRANSPORTATION NETWORK COMPANY COMPLAINT FORM
PLEASE NOTE THE NTA DOES NOT HAVE JURISDICTION OVER INTERSTATE (FROM ONE STATE TO ANOTHER) PASSENGER TRANSPORTATION
*NAME (LAST, FIRST, MI):
ALTERNATE PHONE NUMBER:
TRANSPORTATION NETWORK COMPANY INFORMATION
COMPANY'S WEBSITE (if available):
PERSON(S) CONTACTED AT ABOVE COMPANY:
*DATE OF OCCURRENCE:
TIME OF OCCURRENCE:
LOCATION OF OCCURRENCE:
TRIP START ADDRESS:
TRIP ENDING ADDRESS:
NAME OF DRIVER:
*PAYMENT MADE TO THE COMPANY?
IF SO, AMOUNT PAID:
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.
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