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Used Car Lemon Law Arbitration Program Request For Arbitration Form (New York) CNS 007 - Legal Forms

Used 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 .
 Fillable pdf Last Modified 8/14/2009
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INSTRUCTIONS FOR COMPLETING THE USED CAR LEMON LAW REQUEST FOR ARBITRATION FORM To participate in the New York State Used 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, the NYS Used Car Warranty, all service or work orders relating to the problem for which you seek this arbitration, and any correspondence between you and the dealer relating to such problem). DO NOT SEND ORIGINAL DOCUMENTS. Sign and return the completed form, together with your documents, to: The New York State Attorney General's Office 120 Broadway -- 3rd floor New York, NY 10271 Attention: USED 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 forward it the required $120 filing fee. Upon receipt of the filing fee, NYSDRA will begin processing your claim. If your form is rejected, it will be returned to you with a statement indicating the reason for its rejection. DO NOT SEND THE FILING FEE UNTIL YOU ARE NOTIFIED 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 USED CAR LEMON LAW: A CONSUMER'S GUIDE" 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 USED CAR LEMON LAW ARBITRATION PROGRAM REQUEST FOR ARBITRATION FORM CONSUMER INFORMATION 1. Name: ____________________________________________________________ Address: City: ____________________________________________________________ _____________________________ State:__________ Zip:__________ Phone: Home (______)_____-___________ Work:(______)______-___________ DEALER INFORMATION 2. Name: ____________________________________________________________ Address: City: Phone: ____________________________________________________________ _____________________________State:___________ (______) _____ - _____________ Zip:__________ Fax: (______) _____ - _____________ USED VEHICLE INFORMATION (Attach a copy of your Bill of Sale or Lease) 3. 4. 5. 6. 7. Manufacturer: ____________________________________________________________ (GM, Ford, Chrysler, Toyota, etc.) Year: _________ Make: ____________________ Model: ___________________ (ex. Chevrolet, Dodge) (ex. Cavalier, Caravan) Vehicle Identification Number (VIN):_________________________________________ Date of delivery: _______________________ Mileage at Delivery: ________________ Did you purchase or lease your vehicle in New York?................. Yes[ ] No[ ] [ ] I purchased my vehicle. [ ] I leased my vehicle. Purchase Price: $ ________________________ 1 American LegalNet, Inc. www.FormsWorkFlow.com 8. 9. Is your vehicle primarily used for personal, family or household purposes? ..................................................................... .. Yes[ ] No[ ] Do you still own (or lease) your vehicle? ................................. Yes[ ] No[ ] 10. WARRANTY INFORMATION 11. Which warranty applies to you (choose only one of the following)? (a) 90 days or 4,000 miles from the date of delivery, whichever came first, if the vehicle was purchased or leased with between 18,000 and 36,000 miles?.................. or (b) 60 days or 3,000 miles from the date of delivery, whichever came first, if the vehicle was purchased or leased with between 36,001 and 80,000 miles?................... or (c) 30 days or 1,000 miles from the date of delivery, whichever came first, if the vehicle was purchased or leased with between 80,001 and 100,000 miles? ................ 12. Did you receive a written warranty? (If yes, attach copy).............. Yes[ ] No[ ] Yes[ ] No[ ] Yes[ ] No[ ] Yes[ ] No[ ] BANK OR FINANCING INSTITUTION: 13. Name: ____________________________________________________________ Address: ____________________________________________________________ City: ____________________________ State:____________ Zip: ______________ LEASING COMPANY: 14. Name: ________________________________________________________________ Address:________________________________________________________________ City: _________________ State:_____ 15. Zip:_______ Lease Acct#:____________ Total amount paid to date on lease (monthly payment x number of months, plus down payment):................................................... $______________________ 2 American LegalNet, Inc. www.FormsWorkFlow.com VEHICLE'S PROBLEM(S) 16. Briefly describe the problem for which you now seek relief: ________________________________________________________________________ ________________________________________________________________________ 17. On what date and at what mileage did you first report this problem to the dealer? Date: ______________________ Mileage: _______________________ Does the problem substantially impair the value of the vehicle to you? ................................................................................. Yes [ ] 18. No [ ] BASIS FOR RELIEF SOUGHT 19. Repair Attempts A. How many repair attempts for the same problem were made by the dealer, or authorized by the dealer, within the warranty period that applies to your vehicle (see question #11)? ____________________ Give the date, mileage and work order number for each of the repair attempts by the dealer for the same problem. Problem 1. (Specify) __________________________________________ B. Date (1) (2) (3) ______________ ______________ ______________ Mileage _______________ _______________ _______________ Work Order # _________________ _________________ _________________ 3 American
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