Consumer Mediation Services - Mediation Request Form

Please enter your contact information. Fields with '*' are required entries.

Contact Information  
*First Name:   MI:   *Last Name: 
*Address:       *City: 
State:             *Zip Code: 
*Telephone #:   
(Best number to contact you between 8:00 AM and 5:00 PM.)
*How did you hear about us?
Confirm Email:  

** The New Motor Vehicle Board will correspond with you via e-mail if you provide a valid e-mail address. This saves paper and postage cost.

Your request form will be sent to the New Motor Vehicle Board once you have entered,
reviewed and submitted your information. Click "Next" to continue.

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1507 21st Street, Suite 330
Sacramento, CA 95811
Phone: (916) 445-1888
FAX: (916) 323-1632