Legal Forms > Consumer > Lemon Law
Lemon Law Complaint Form (Texas) MVD-140 - Legal Forms
| Lemon Law Complaint Form (Texas) Form. This is a Legal Forms form and can be used in Lemon Law Consumer . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
LEMON LAW COMPLAINT FORM MVD-140 Rev. 1/04 Page 1 of 4 OWNER: MAILING ADDRESS: CITY: WORK PHONE: CHECK ALL THAT APPLY: YEAR: VIN: NEW STATE: HOME PHONE: USED DEMO PROGRAM MODEL: ZIP: FAX LEASE CONVERSION MFG/MAKE: DATE PURCHASED: MILEAGE: CURRENT AT DELIVERY: DATE 24,000 MILES REACHED: NOT APPLICABLE TO TOWABLE RECREATIONAL VEHICLES CONVERSION CO: LEASE CO: SELLING DEALER: SERVICING DEALERS 1) 2) 3) DEALER ADDED OPTIONS: CITY: CITY: CITY: CITY: WHAT REMEDY ARE YOU SEEKING?: REPURCHASE/REPLACEMENT OR REPAIRS EXISTING PROBLEMS LOG: You MUST complete this section on this form or the form will be returned as incomplete. "See Attached" or equivalent is NOT a substitute for completion. Description of problem that CONTINUES TO EXIST: list only one problem Repair Visits 1st visit 2nd visit 3rd visit 4th visit Date In Date Out Mileage LL $35 American LegalNet, Inc. www.FormsWorkFlow.com MVD-140 Rev. 1/04 Page 2 of 4 CONTINUATION OF EXISTING PROBLEMS LOG: You MUST complete this section on this form or the form will be returned as incomplete. "See Attached" or equivalent is NOT a substitute for completion. You may make copies of this page to address additional concerns. Description of problem that CONTINUES TO EXIST: list only one problem Repair Visits 1st visit 2nd visit 3rd visit 4th visit Date In Date Out Mileage Description of problem that CONTINUES TO EXIST: list only one problem Repair Visits 1st visit 2nd visit 3rd visit 4th visit Date In Date Out Mileage Description of problem that CONTINUES TO EXIST: list only one problem Repair Visits 1st visit 2nd visit 3rd visit 4th visit Date In Date Out Mileage Description of problem that CONTINUES TO EXIST: list only one problem Repair Visits 1st visit 2nd visit 3rd visit 4th visit Date In Date Out Mileage American LegalNet, Inc. www.FormsWorkFlow.com MVD-140 Rev. 1/04 Page 3 of 4 YES NO The manufacturer, converter or distributor of the vehicle (NOT THE DEALER) was given written notice of the problem(s), on , 20 . IF YOU ANSWERED NO, PLEASE SEND A LETTER TO THE MANUFACTURER, CONVERTER OR DISTRIBUTOR AS SOON AS POSSIBLE (CERTIFIED MAIL/RETURN RECEIPT IS SUGGESTED) AND INCLUDE A COPY OF THE LETTER WITH THIS COMPLAINT FORM. YES NO The vehicle has been inspected by a factory representative. If you answered yes, please provide the inspection date, location, personnel involved, and outcome. Use a separate sheet if needed DATE: BY WHOM: LOCATION: OUTCOME: I UNDERSTAND THAT THE INFORMATION I AM SUBMITTING MAY BE SHARED WITH THE OTHER INTERESTED PARTIES TO MY COMPLAINT IN ORDER TO RESOLVE THIS MATTER. THE UNDERSIGNED HEREBY CERTIFIES, UNDER PENALTY OF PERJURY, THAT ALL STATEMENTS IN THIS COMPLAINT ARE TRUE AND CORRECT. SIGNATURE OF REGISTERED VEHICLE OWNER/LESSEE DATE The Texas Department of Transportation maintains the information collected through this form. With few exceptions, you are entitled on request to be informed about the information that we collect about you. Under Section 552.021 and 552.023 of the Government Code, you also are entitled to receive and review this information. Under Section 559.004 of the Government Code, you are also entitled to have us correct information about you that is incorrect. For more information, call (512) 416-4800. American LegalNet, Inc. www.FormsWorkFlow.com MVD-140 Rev. 1/04 Page 4 of 4 Forms submitted incomplete and/or without the attachments requested below will be returned. This delay could result in your complaint being rejected due to untimely filing. Please return this form with the following attachments: DO NOT SEND ORIGINAL DOCUMENTS. PHOTOCOPIES ONLY. 1. 2. 3. 4. 5. 6. Purchase order or sales contract. Repair order(s). Extended service contract, if applicable. Lease agreement, if applicable. Other relevant information. IF YOU ARE SEEKING REPURCHASE OR REPLACEMENT OF YOUR VEHICLE, you must send this form and the requested attachments with your check or money order payable to the Motor Vehicle Division or a completed credit card payment form for the amount of $35.00 (NO CASH) to the following address: Texas Department of Transportation Motor Vehicle Division Consumer Affairs Section Post Office Box 13044 Austin, Texas 78711-3044 7. IF YOU ARE SEEKING REPAIRS ONLY, you must send this form and the requested attachments to the following address: Texas Department of Transportation Motor Vehicle Division Consumer Affairs Section Post Office Box 2293 Austin, Texas 78768-2293 American LegalNet, Inc. www.FormsWorkFlow.com
|
|||||||
