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Motor Vehicle Lemon Law Request For Arbitration (Washington) - Legal Forms
| Motor Vehicle Lemon Law Request For Arbitration (Washington) Form. This is a Legal Forms form and can be used in Lemon Law Consumer . |
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EMON AW Motor Vehicle File No. Consumer: Vehicle: VIN No. RCW 19.118 REQUEST FOR ARBITRATION BEFORE YOU COMPLETE THIS FORM . . . 1. Read the Motor Vehicle Lemon Law booklet. If you have any questions after reading the booklet contact the Lemon Law Administration at the telephone numbers listed below. 2. The minimum eligibility requirements for a vehicle are: · it must have been originally sold/leased at retail in Washington; and · the vehicle must also have had its initial registration in Washington (a non-resident military exemption may apply regarding the registration requirement). 3. The following are the minimum diagnosis/repair attempt requirements for a defect to provide the basis for a claim: · two (2) attempts to diagnose or repair an existing 'serious safety defect'; or · four (4) attempts to diagnose or repair an existing substantial defect ('nonconformity'); or · the vehicle must have been out of service for 30 or more cumulative calendar days to diagnose or repair one or more substantial defects. NOTE: THESE ARE NOT THE COMPLETE ELIGIBILITY REQUIREMENTS OF THE LEMON LAW. Read the Lemon Law booklet carefully to be certain that your vehicle meets ALL the eligibility requirements. 4. A written request for repurchase or replacement of the vehicle must be sent to the vehicle's manufacturer to initiate the arbitration process. The manufacturer should be allowed 40 days to respond before you submit this form to the Attorney General's Office. 5. For a claim to be accepted for arbitration, a Request for Arbitration form must be received at one of the addresses listed below within 30 months of the vehicle's original retail delivery date WHETHER OR NOT THE MANUFACTURER'S 40 DAY RESPONSE PERIOD HAS EXPIRED. INSTRUCTIONS 1. Type or Print clearly and fully complete the Request for Arbitration form. Failure to complete this Request for Arbitration form or supply the requested documents may result in delay or rejection of your request for arbitration. A copy of your Request for Arbitration form and documents will be provided to the manufacturer if your claim is accepted for arbitration. 2. Attach copies of documents or records requested (Do Not Submit Originals). If you do not have the document(s) requested, send a written request to the source (i.e. dealer, manufacturer, etc.) asking for the needed documentation. If you do not receive the documents, include a copy of the letter requesting the document(s) or an explanation why the copies cannot be provided with this form. 3. Submit your Request for Arbitration form and copies of documents to the address nearest you: Lemon Law Administration Office of the Attorney General 800 5th Avenue, Suite 2000, TB-14 Seattle, WA 98104-3188 4. For additional information: CALL TOLL FREE: 1-800-541-8898 Lemon Law Administration Office of the Attorney General 1116 W Riverside Avenue Spokane, WA 99201-1194 INTERNET: www.atg.wa.gov LOCAL NUMBERS: KING COUNTY: 206-587-4240 and SPOKANE COUNTY: 509-456-3123 EMAIL: LEMON@ATG.WA.GOV FAX: 206-464-6451 American LegalNet, Inc. www.FormsWorkFlow.com AG Form LL-10 Revised January 2007 I. CONSUMER INFORMATION Name: Please Print or Type Last First Middle Initial Address: City: Phone: Day: ( Email: ) Evening: ( ) State: Cell phone: ( Other registered owners: ZIP: ) II. VEHICLE INFORMATION Make: (Chevrolet, Ford, Dodge, Nissan, etc.) Model: (F-150, Grand Cherokee, etc.) Year: Style: (Car, Motorcycle, Truck, SUV, etc.) Vehicle ID Number (VIN): Original Delivery Date (month/day/year): Original Sales/Lease Dealer: Address: City: State in which vehicle was originally registered: State: License Plate No.: Present Mileage: ZIP: Vehicle currently registered in: Yes No Are you the original Owner? If no, you must submit a title history obtained from the Department of Licensing (call the Records Section at 360-902-4000 with the vehicle's license number). III. PREVIOUS CLAIMS 1. Have you previously filed a Request for Arbitration form regarding this vehicle? Yes No Yes No No 2. Have you participated in any other dispute resolution program regarding this vehicle? If yes, identify program: Claim No. 3. Has there been any court action regarding the claim you are making now? Yes NOTE: If you answer yes, you must provide an explanation of current status and submit copies of relevant documents. IV. REQUIRED DOCUMENTS You must submit copies of the following documents. (See Instruction #2 on the front page of this form if you cannot provide all documentation.) Check the boxes below to identify the document copies that are submitted with this form. DO NOT SEND ORIGINAL DOCUMENTS! Letter to the Manufacturer Requesting Replacement or Repurchase Repair Orders Listed in Section V Current Registration Other: Date Letter Mailed/Received: Finance Agreement (if applicable) Purchase/Lease Agreement You must provide a written explanation and/or a copy of letter(s) to the information source requesting the missing documents regarding copies of all documents not submitted with this form. American LegalNet, Inc. www.FormsWorkFlow.com V. REPAIR HISTORY If there is more than one defect, list each individually. When necessary, attach additional pages. Identify each attempt to diagnose or repair each defect. A repair order should be listed more than once if it relates to more than one defect. You must submit copies of repair orders; if any repair orders will not be submitted see Instruction #2. Defect 1 Description: Is this a 'serious safety defect'? Yes No Does the defect currently exist in the vehicle? Yes No Repair Copy Date to Date Vehicle Order# Enclosed Dealer Returned to You Dealership Name Mileage Defect 2 Description: Is this a 'serious safety defect'? Yes Repair Copy Date to Order# Enclosed Dealer Defect 3 Description: Is this a 'serious safety defect'? Yes Repair Copy Date to Order# Enclosed Dealer Defect 4 Description: Is this a 'serious safety defect'? Yes Repair Copy Date to Order# Enclosed Dealer No Does the defect currently exist in the vehicle? Date Vehicle Returned to You Dealership Name Yes Mileage No No Does the defect currently exist in the vehicle? Date Vehicle Returned to You Dealership Name Yes Mileage No No Does the defect currently exist in the vehicle? Date Vehicle Returned to You Dealership Name Yes Mileage No Check this box and provide a description on additional pages if you can list more than four (4) attempts to diagnose or repair a defect, or if your claim is based on more than four (4) defects. Check this box if you
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