Vehicle Leasing Feedback Form

Kansas Department of Administration, Division of Facilities Management

Vehicle Leasing Feedback Form - Hertz

Please provide us with feedback as to what went well and/or what went wrong with your recent experience with Hertz and what we can do to improve the experience. Please complete as many of the fields of this form as possible. The more information that you give us the better we will be able to serve you.

All fields marked with an * are required and must be completed.

Contact Information:* First Name:
* Last Name:
Phone #: (123-123-1234)
* Email Address:

Comment/Feedback:* Is this feedback positive or negative?

If your feedback refers to a specific rental, please give us as much information as possible.

* Name of Agency:

Division/Section:

Did you reserve a vehicle 24 hours or more in advance? Yes or No

* Date of Rental: (mm/dd/yyyy)
Reservation Number:

* Rental Location (City): Other:

If the vehicle was picked up in Overland Park, or Wichita,
please select the location within that City:

State, if other than Kansas

Length of Rental: (For example: 3 hours; 2 days, etc.)

Reason for feedback (check all that apply): No Vehicle or Substitute Vehicle available.

If a vehicle was substituted, what did you receive:

Less than full fuel tank
Vehicle Condition (i.e. cleanliness, mechanical problem)

* Please specify: (200 characters maximum)

Customer Service(i.e. rude, excessive waiting time)

* Please specify: (200 characters maximum)

   Vehicle Damage Reporting or Dispute
   Billing Errors
   Other

Please specify reason:

Your Comments/Concerns/Complaints/Feedback:

Upon clicking the "Send Comment" button, you will receive the Vehicle Comment - Submission Results which is a copy of what you submitted. You may print this form for your records. You will also receive an automated reply from Vehicle.Rental@da.ks.gov.