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New Car Lemon Law Arbitration Program Request For Arbitration Form (New York) CNS 006 - Legal Forms
|New Car Lemon Law Arbitration Program Request For Arbitration Form (New York) Form. This is a Legal Forms form and can be used in Lemon Law Consumer .||
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INSTRUCTIONS FOR COMPLETING THE NEW CAR LEMON LAW REQUEST FOR ARBITRATION FORM To participate in the New York State New Car Lemon Law Arbitration Program, you must complete the attached form. Be as accurate and complete as possible. Please attach copies of all relevant documents (including your purchase or lease agreement, all service or work orders relating to the problem for which you seek this arbitration, and any correspondence between you and the manufacturer or its authorized dealer relating to such problem). DO NOT SEND ORIGINAL DOCUMENTS. Sign and return the completed form, together with your documents, to: New York State Attorney General's Office 120 Broadway --3rd floor New York, NY 10271 Attention: NEW CAR LEMON LAW ARBITRATION UNIT. The Attorney General's Office will review your form and advise you whether your claim is accepted in the arbitration program. If the form is accepted, you will be notified by the Attorney General's Office which will then forward your form and documents to the New York State Dispute Resolution Association (NYSDRA), the Program Administrator. NYSDRA will then notify you to send it the required $250 filing fee. Upon receipt of the filing fee, NYSDRA will begin processing your claim. If your form is rejected by the Attorney General's Office, it will be returned to you with a statement indicating the reason for its rejection. DO NOT SEND FILING FEE UNTIL YOU ARE REQUESTED TO BY NYSDRA. Please remember to sign and date the form. Failure to complete any question or submit documents may result in a rejection of the form. ________________________________________________________________________ NOTICE: THE ARBITRATOR'S DECISION UNDER THIS PROGRAM IS BINDING ON BOTH PARTIES, SUBJECT TO A LIMITED RIGHT OF APPEAL TO COURT BY EITHER PARTY. YOU MAY WISH TO CONSULT AN ATTORNEY BEFORE PARTICIPATING IN THIS PROGRAM. PLEASE READ "NEW YORK'S NEW CAR LEMON LAW: A GUIDE FOR CONSUMERS" CAREFULLY BEFORE COMPLETING THIS FORM. ________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com Office Use Only: Case No. __________________ Referred To NYSDRA ___________ Filing Date __________________ NEW YORK STATE ATTORNEY GENERAL'S OFFICE ANDREW M. CUOMO, ATTORNEY GENERAL NEW YORK NEW CAR LEMON LAW ARBITRATION PROGRAM REQUEST FOR ARBITRATION FORM CONSUMER INFORMATION 1. Name: _____________________________________________________________________ Address: City: _______________________________________________________________ ____________________________ State:__________Zip:________________ Phone: Home (______)_____-_______________ Work:(______)_____-_______________ VEHICLE INFORMATION (Attach Copy of Your Bill of Sale or Lease) 2. Manufacturer: ______________________________________________________________ (GM, Ford, Chrysler, Toyota, Winnebago, etc.) Year: _________ Make: _______________ (ex. Chevrolet, Dodge) Model: __________________________ (ex. Cavalier, Caravan) 3. 4. 5. 6. Vehicle Identification Number (VIN):____________________________________________ Date of delivery?_________ Mileage at delivery:______ Current Mileage: ____________ Did you purchase or lease your vehicle in New York? .................... Yes[ ] No[ ] [ ] I purchased my vehicle.  I leased my vehicle. Is your vehicle registered in New York?........................................ Is your vehicle primarily used for personal, family or household purposes? ............................................................... Yes[ ] No[ ] 7. 8. Yes[ ] No[ ] No[ ] 9. Do you still own or lease your vehicle? .......................................... Yes[ ] 1 American LegalNet, Inc. www.FormsWorkFlow.com DEALER INFORMATION 10. Name: _____________________________________________________________________ Address: City: _______________________________________________________________ _______________________ State:___________ Zip:____________________ BANK OR FINANCING INSTITUTION (if financed): 11. Name: _____________________________________________________________________ Address: City: _______________________________________________________________ _______________________ State:____________ Zip:___________________ LEASING COMPANY (if leased): 12. Name: _____________________________________________________________________ Address: City: _______________________________________________________________ _______________________ State:_____________Zip:__________________ Lease Acct #: _______________________________________________________________ VEHICLE'S PROBLEM(S) 13. Briefly describe the problem(s) for which you seek a refund or a replacement vehicle: ___________________________________________________________________________ ___________________________________________________________________________ 14. Does the problem(s) for which you seek relief substantially impair the value of the vehicle to you? .................................................... Yes [ ] No [ ] On what date and at what mileage did you first report this problem(s) to the dealer or the manufacturer? Date: ____________ Mileage: ____________________ Does the problem(s) involve a dealer installed option? .................. Yes [ ] No [ ] Specify: ____________________________________________________________________ 15. 16. 2 American LegalNet, Inc. www.FormsWorkFlow.com BASIS FOR RELIEF SOUGHT: You must complete at least one of the following three questions (17, 18 or 19). If you have a Motor Home, you must also answer # 20. 17. Unsuccessful Repair Attempts A. How many repair attempts for the same problem were made within the first 18,000 miles or 24 months, whichever is earlier? _______________ Give the date, mileage and work order number for each of the repair attempts by an authorized dealer for the same problem. Problem 1 (Specify) ____________________________________ Date (1) (2) (3) (4) ______________ ______________ ______________ ______________ Mileage _______________ _______________ _______________ _______________ Work Order # ____________________ ____________________ ____________________ ____________________ B. Problem 2 (Specify) _______________________________________ Date (1) (2) (3) (4) C. ______________ ______________ ______________ ______________ Mileage _______________ _______________ _______________ _______________ Work Order # ____________________ ____________________ ____________________ ____________________ Do you have copies of all relevant work orders?...............