NOTE: If you do not have an email address, or cannot fill in a required field, please phone the Vehicle Safety Hotline (Toll-Free: 1-888-327-4236 / Hearing Impaired (TTY): 1-800-424-9153) for assistance.
Form Approved: O.M.B. No. 2127-0008
Please complete each section and then click on the "Verify your entries" button at the bottom.