New Car Lemon Law Dispute Resolution Application Page 4
Download a blank fillable New Car Lemon Law Dispute Resolution Application in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete New Car Lemon Law Dispute Resolution Application with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
419. Give a chronology of the repair attempts for the defect.
Brief description of problem(s)
1
Defect
Date
Mileage
Days out of service
st
__________________________________________________
_______________
_________________
_________
__________________________________________________
_______________
_________________
_________
__________________________________________________
_______________
_________________
_________
__________________________________________________
2
Defect
Date
Mileage
Days out of service
nd
__________________________________________________
_______________
_________________
_________
__________________________________________________
_______________
_________________
_________
__________________________________________________
_______________
_________________
_________
__________________________________________________
20. Do any of the problems continue to exist?
Yes
No
If “Yes,” please explain: ___________________________________________________________________________________
_______________________________________________________________________________________________________
21. Please check one:
The defect substantially impairs the use, value or safety of the vehicle.
The defect is a “serious safety defect” which is likely to cause death or serious bodily injury if the vehicle is driven.
Additional Information
22. Have you previously participated in any arbitration for the nonconformity for which you are now seeking relief?
Yes
No
If “Yes,” what was the date of the final arbitration decision? __________________________________
Did you accept the decision?
Yes
No
If “Yes,” please explain and give the current status: (Use additional sheets of paper if needed.)
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
I certify that the manufacturer has not yet given me a refund or replacement, and that all statements made in connection with
this request for dispute resolution are true to the best of my knowledge. I understand that this document and its attachments are a
part of the public record.
I am aware that I can participate in the dispute resolution process regarding this motor vehicle only once and that further
applications will not be accepted after a final decision is issued in this case.
_____________________________________________________
____________________________
Signature
Date
If you have not already done so, please attach a copy (do not send the original) of the following documents:
• Final repair opportunity letter to the manufacturer
• Purchase order
• Certified mail return receipts
• Finance agreement
• All relevant evidence of repair attempts
• Lease agreement
• Sales invoice
• Work orders/repair invoices
• All towing charges, rental fees, expert witness fees and legal fees
• Vehicle registration
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal