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Lemon Law Dispute Resolution Application (New Jersey) - Legal Forms
| Lemon Law Dispute Resolution Application (New Jersey) Form. This is a Legal Forms form and can be used in Lemon Law Consumer . |
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State of New Jersey DEPARTMENT OF LAW AND PUBLIC SAFETY DIVISION OF CONSUMER AFFAIRS OFFICE OF CONSUMER PROTECTION LEMON LAW UNIT P.O. BOX 45026 NEWARK, NEW JERSEY 07101 (973) 504-6226 (800) 242-5846 E-MAIL: AskConsumerAffairs@lps.state.nj.us WEBSITE: www.njconsumeraffairs.com Instructions for Completing the Application for Lemon Law Dispute Resolution Please complete the attached application either by typing or printing legibly in dark ink. Be accurate and thorough. You must attach copies of all relevant documents, including the sales contract or lease agreement, service or work orders and correspondence between you and the manufacturer, or its authorized dealer, relating to the problem(s). Do not send your original documents. Sign and return the completed application, together with copies of the documents, to the New Jersey Division of Consumer Affairs, Lemon Law Unit, P.O. Box 45026, Newark, NJ 07101. The Lemon Law Unit will review your application for completeness and eligibility. If the application is accepted, you will be notified and asked (only after acceptance) to forward a filing fee of $50. Do not send the filing fee until you are notified to do so. If your application is rejected, it will be returned to you with a statement of the reason(s) for its rejection. Please remember to sign and date the application. Your failure to complete any questions or submit all required documents may result in the rejection of your application. Notice The decision of the Director of the Division of Consumer Affairs under this program is binding on both parties, subject to a right of appeal to the Superior Court by either party. You may wish to consult an attorney before participating in this program, since the manufacturer will be represented by an attorney. American LegalNet, Inc. www.FormsWorkFlow.com Internet State of New Jersey DEPARTMENT OF LAW AND PUBLIC SAFETY DIVISION OF CONSUMER AFFAIRS OFFICE OF CONSUMER PROTECTION LEMON LAW UNIT P.O. BOX 45026 NEWARK, NEW JERSEY 07101 (973) 504-6226 (800) 242-5846 E-MAIL: AskConsumerAffairs@lps.state.nj.us Lemon Law Dispute Resolution Application Consumer Information NAME: __________________________________________ ADDRESS: ________________________________________ CITY: ____________________________________________ STATE: ________________________ ZIP: _____________ (include area code) FOR OFFICE USE ONLY LL case number: ____________________________ Assigned to: ____________________________ Date accepted: ____________________________ OAL docket number: ____________________________ Date completed: ____________________________ Approved by: ____________________________ HOME TELEPHONE NUMBER: ___________________________ WORK TELEPHONE NUMBER: __________________________ (include area code) FAX TELEPHONE NUMBER: ___________________________ (include area code) E-MAIL ADDRESS: __________________________________ For statistical and informational purposes only. Your age: 18-29 30-44 45-59 60 or older Attorney Information (If an attorney is going to represent you, please provide the following information.) Attorney's name: _________________________________________________________________________________________ Law firm: _______________________________________________________________________________________________ Address: ________________________________________________________________________________________________ City: ________________________________________________ State: _______________________ ZIP code: _____________ Telephone number: _____________________________________ FAX number: ______________________________________ (include area code) (include area code) Vehicle Information 1. Is the vehicle registered in New Jersey? If "No," was the vehicle purchased or leased in New Jersey? 2. Yes Yes No No Manufacturer: __________________________________________________________________________________________ Make: ____________________________________________ Year: ________________ Color: __________________ Model: __________________________________________ Body type: _______________________________________ Yes No 3. 4. 5. Is your vehicle normally used for commercial purposes? What was the mileage on delivery? _____________________ Date of delivery: ___________________________________ Month Day Year Present mileage: _____________________ American LegalNet, Inc. www.FormsWorkFlow.com 6. 7. The vehicle identification number (the VIN can be found on the registration): ________________________________________ Dealer from which the vehicle was purchased or leased: Name: ___________________________________________________Telephone number : _____________________________ (include area code) Street Address: ___________________________________________________________________________________________ City: ______________________________________ State: ______________________________ ZIP code: _______________ 8. Company to which you make monthly payments: Name: ___________________________________________________Telephone number : _____________________________ (include area code) Street Address: ___________________________________________________________________________________________ City: ______________________________________ State: ______________________________ ZIP code: _______________ If the vehicle was purchased, give the loan account number: _______________________________________________________ Financial Information (You should review your sales or lease agreement for the costs.) 9. Total Sales Price, including: any fees, taxes and finance charges _______________ _______________ 10. Less any rebates 11. Total Purchase Price (Subtract: 9 - 10) 12. Other Costs, including: any towing charges, rental fees, cost of modifications 13. Cash Amount Paid at the Time of Purchase, including: security deposit and trade-in allowance 14. Total Amount of Monthly Payments made to date ( ______________ ) X ( _______________ ) monthly payment the number of months = _______________ _______________ + _______________ + _______________ = _______________ 15. Total Amount Paid (Add: 12, 13 and 14) Nonconformity Repair Information 16. Briefly describe the defect which substantially impairs your vehicle's use, value or safety. (Use additional sheets of paper if needed.) ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ 17. I
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