CAPA Complaint Form

By completing theCCRE complaint form to CAPA you will be making a traceable record (at both CAPA  and theCCRE) as to your specific experiences with CAPA "Certified" parts. theCCRE will be keeping a  separate database of all the information collected from this form and will be making this data  available to any qualified independent investigative entities (Attorney's, Journalists,  Legislators, etc.) or involved participants wishing this information.

theCCRE recommends you print this form for your records before you prompt the  "send  complaint" button.

Date:  May we release your name to the manufacturer? Yes No

Car Make:
Car Model:
Year of Car:

Please select type of part  (select one only): Bumper Cover Front Hood Bumper Cover, Rear Lamp Cover Door Shell Left Quarter Panel Door Shell, Right Radiator Support Fender, Left Side Molding Fender, Right Tail Gate Grille Truck Bed Header Panel Trunk Lid Headlight Bezel

 Please supply the following information about the part:

CAPA Manufacturer:
CAPA Part Number:
Lot Number   (Stamped on Part):
CAPA Seal Number:
OEM #:

You are a: Collision Repairer Distributor Insurance Adjuster Other (specify):

 Please supply the following information about yourself:

Your Name:
Your Company:
Address Line 1:
Address Line 2:
City:
State:	Choose a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware D.C. Florida Georgia Hawii Idaho Illinios Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnisota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconson Wyoming
Zip:
Phone:
Fax:
Email:

  Please supply the following information about the part's distributor:

Distributor Name:
Address Line 1:
Address Line 2:
City:
State:	Choose a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware D.C. Florida Georgia Hawii Idaho Illinios Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnisota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconson Wyoming
Zip:
Phone:
Fax:
Email:

  What was wrong with the part? (Give details below. Select as many as you like.)

Adhesive - Too Much Adhesive - Too Little Appearance - Ripples Appearance - Dings Appearance - Mold Overflow Body Line - Poor Contour - Poor (Corners & Edges Poorly Formed) Cut - Poor (Light or Grille Cut Our Location) Gap - Inconsistent Gap - Too Wide Fit - Poor Not Flush with Adjacent Parts Grind Marks Evident Holes/Brackets - Poorly Placed Holes/Brackets - Wrong Size Installation (Significantly Exceeded Book Time)

Length - Too Long Length - Too Short Latch Problems Packing Inadequate Paint - Inconsistent Paint - Doesn't Adhere Well Seal Missing Shipping Damage Evident Studs - Inappropriate Location Surface - Wavy Width - Too Wide Width - Not Wide Enough Welds - Missing Welds - Weak Welded Fastener - Inappropriate Location

  Location of Problem/Comments/Other:       
 
 

  Is the part available for inspection, if necessary? Yes No

 Are Photos Available? Yes No

 Did you return the part to the distributor? Yes No

 Did you end up using OEM to complete this job? Yes No

 Was this part recommended by an insurance company? Yes No

 If "Yes" . . . Please provide - Name of Insurance Company:

Thank you for completing theCCRE complaint form to CAPA. Press the "send complaint" button to finish.

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