Consumer Dispute Instructions

You can dispute your driving record one of three ways; by fax, US Mail or electronically. It’s important to follow the instructions to avoid delays.

Submitting your Dispute via Fax or US Mail

If you would like to submit a dispute via fax or US Mail, click on the button on the right to download and print a copy. To avoid delays, make sure that each field is completed and you initial and sign where indicated.

You MUST also include a CLEAR copy of your current driver’s license.  Without the copy, we cannot proceed with your dispute. If you have any supporting documentation, fax or mail in a copy along with your driver’s license.  Please note that all disputes will be answered in the ordered that they are received and will be processed within 30 days.

When faxing a copy of your driver’s license it has a tendency of transmitting very dark.  You may want to lighten the resolution on the copy machine before making the copy and faxing it in. If the fax that we receive is too dark, we will contact you and ask that you mail a copy to us directly.

The mailing address and fax number are listed below.

SambaSafety
Attn:  Compliance Department
P.O. Box 92890
Albuquerque, NM 87199-2890
Fax: 877-709-1235

 

Submitting your Dispute Electronically

You also have the option of submitting your dispute electronically via DocuSign by clicking the button below.

We ask that you do not activate the electronic process unless you are ready to complete the dispute form and have a copy of your driver’s license ready to upload and any supporting documentation as this is a legally binding document. If you have more than one page to upload, you need to create a PDF file that includes the copy of your driver’s license and supporting documentation. Here is a link that will show you how to create a PDF file.

Executing the electronic submission and not completing the process or an attempt to submit more than one form will result in being locked out. You will then have to submit your Dispute via Fax or U.S. Mail.

When you click on the Consumer Dispute Electronically button, you’ll be asked to enter your name (enter First Name and Last Name) and your email address then click on the Begin button to complete the form.  Complete the form in its entirety, check Yes and initial if you want us to reply via email, upload a clear copy of your driver’s license and any supporting documentation you might have, sign the document and click the Finish button.

You will receive an email message letting you know that your request has been received by the SambaSafety Compliance Department.  Please note that all requests are answered in the ordered that they are received.

If you give us permission to reply via email, you will receive a password protected copy of your driving record which can be opened using your driver’s license number.  The driver’s license number must be entered exactly as it appears on your driver’s license.

If you have more than 1 page to upload, please create one document that includes the copy of your driver’s license and any other documentation that you would like to include and then upload your document.