MO 300-1864i (4-05)

MISSOURI OFFICE OF ADMINISTRATION

STATE FLEET MANAGEMENT PROGRAM

ELECTRONIC VEHICLE COMPLAINT FORM

FIRST NAME

LAST NAME

EMAIL ADDRESS

EMAIL ADDRESS (Confirm)

Please provide as much information as possible including the license plate number, a description of the complaint,

vehicle and time and place of the incident. If you are unsure about the license plate number, please provide as

much of it as possible and include any comments about the number in the complaint details box below.

LICENSE PLATE NUMBER

MAKE

OTHER VEHICLE INFORMATION

COLOR

MODEL (If known)

DATE OF INCIDENT

LOCATION OF INCIDENT (Such as street, highway, intersection, direction of travel)

DETAILS OF COMPLAINT

TIME OF INCIDENT

GENERAL NATURE OF THE INCIDENT

Your PERSONAL INFORMATION (name and email address) are optional fields. If you wish to remain anonymous,

you do not have to provide this information. If you do provide your name and email address, it will not be

forwarded to the state agency owning the vehicle.