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Used Car Lemon Law Complaint Form. (New Jersey) - Legal Forms
| Used Car Lemon Law Complaint Form. (New Jersey) Form. This is a Legal Forms form and can be used in Lemon Law Consumer . |
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New Jersey Office of the Attorney General Division of Consumer Affairs Used Car Lemon Law Unit P.O. Box 45026 Newark, New Jersey 07101 (973) 504-6226 (800)-242-5846 E-Mail: lemonlaw@dca.lps.state.nj.us Please be advised that any information you supply on this complaint form may be subject to public disclosure. If an investigation into the matter is conducted, the information is subject to public disclosure only after the completion of the investigation. You are also advised that the completed complaint form is a "government record," which the Used Car Lemon Law Unit may be obligated to provide to anyone making a request pursuant to the Open Public Records Act (OPRA). Consumer InformatIon: Dealer InformatIon: name: _________________________________________ aDDress:_______________________________________ CIty: __________________________________________ state: _______________________ ZIP: ____________ (include area code) BusIness: ______________________________________ aDDress:_______________________________________ CIty: __________________________________________ state: _______________________ ZIP: ____________ telePHone numBer (1): ___________________________ (include area code) Home telePHone numBer: _________________________ Work telePHone numBer: _________________________ (include area code) telePHone numBer (2): ___________________________ (include area code) e-maIl aDDress: ________________________________ 1. Vehicle Information Make ______________________________ Date of Purchase _____________________ Model _________________________________ Purchase Price __________________________ Year ________________ 2. VehicleIdentificationNumber(VIN)________________________________________________ 3. 4. 5. 6. 7. Mileage, on date of purchase: _____________________ a. b. Mileage, at present: ______________________ Yes Yes No No No Is your vehicle normally used for personal, family or household purposes? Is your vehicle normally used for commercial purposes? Does the material defect substantially impair the use, value or safety of the vehicle? Yes Were you advised, in writing, at or prior to the time of purchase that the vehicle was declared a total loss by an insurance company? Yes No Warranty Information (Please check all that apply.) I purchased the vehicle AS IS. I was given a limited dealer warranty at no extra charge. Durationofwarranty: 30days/1,000miles 90days/3,000miles 60days/2,000miles Other________________________ I purchased an extended service contract. (Please provide a copy.) Warranty Company: ___________________________________________________________________________________ Street Address: ___________________________ City: ____________________ State:______ ZIP: ___________ American LegalNet, Inc. www.FormsWorkFlow.com TelephoneNumber(includeareacode):___________________________________ 8. a. Ifthevehicle'smileagewasmorethan60,000atthetimeofpurchase,didyouwaivethewarranty? Yes b. Didyousignawaiverform? Yes No If"Yes,"pleaseprovideacopyofthewaiver. 9. RepairInformation(Useadditionalsheetsofpaperifneeded.) No Whatisthemalfunctionormaterialdefectyouareclaiming?______________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ No b. If"Yes,"onwhatdate?__________________________ Whatwasthemileageatthattime?______________________ Yes No 10. a. Didyounotifythedealeroftheproblemdescribedinquestion#9? Yes 11. Werethree(3)ormorerepairattemptsmadeforthesameproblem? Yes No 12. Wereallthree(3)repairattemptsmadewithinthewarrantyperiod? 13. Doanyoftheallegeddefectsstillexist? a. b. c. Foreachallegeddefect: Description of problem Date & Mileage of each repair attempt Date:____________ Mileage_________________ 1stAttempt Date:____________ Mileage_________________ 2ndAttempt Date:____________ Mileage_________________ 3rdAttempt Date:____________ Mileage_________________ 1stAttempt Date:____________ Mileage_________________ 2ndAttempt Date:____________ Mileage_________________ 3rdAttempt Date:____________ Mileage_________________ 1stAttempt Date:____________ Mileage_________________ 2ndAttempt Date:____________ Mileage_________________ 3rdAttempt Yes No Yes No 14. a. Wasthevehicleoutofserviceforatotalof20ormorecalendardays,duetorepairs? b. If "Yes," how many days? ______________ c. List the dates below: 1. From ______________________________ to 2. From ______________________________ to 3. From ______________________________ to 15. a. b. ___________________________ ___________________________ ___________________________ number of days______________ number of days______________ number of days______________ Was the vehicle repaired by anyone other than the dealer or its agent? Yes No If "Yes," where? Name: ______________________________________________________________________________________________ Street Address: ___________________________ City: __________________ State: _______ ZIP: ___________ County: _________________________________ TelephoneNumber(includeareacode): _________________________ American LegalNet, Inc. www.FormsWorkFlow.com 16. Financial Information Total purchase price $ _______________________________________ Trade-in allowance $ _________________________ Downpayment(forthatportionofthepurchasepricethatisfinanced)$ ________________________ Monthlypayment(forthatportionofthepurchasepricethatisfinanced)$ ______________________ Total amount of monthly payments made to date (monthly payment X number of payments) $ ____________________________ Registration, title and other government fees $ ______________________________________ Total amount paid (excluding sales tax) $ __________________________ Sales tax $ _____________________________ Nameoflienholder:_______________________________________________________________________________________ Street Address: ______________________________ City: _____________________ State: _________ ZIP: _____________ AccountNumber:___________________________TelephoneNumber(includeareacode): __________________________ 17. Additional Information Have you participated in any previous arbitration for the same problem(s) for which you are seeking relief? Yes No a. If "Yes," what type of arbitration? _______________________________ Date of arbitration______________________ b. Did you accept the decision? Yes No If "Yes," please explain and give the curren
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