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Vehicle Repurchase Or Replacement Request (Georgia) B - Legal Forms
| Vehicle Repurchase Or Replacement Request (Georgia) Form. This is a Legal Forms form and can be used in Lemon Law Consumer . |
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VEHICLE REPURCHASE OR REPLACEMENT REQUEST As detailed below, this constitutes my request as a consumer for a repurchase or a replacement vehicle, pursuant to the Georgia Lemon Law, O.C.G.A. Section 10-1-784(b)(1). Vehicle Make _____________________________ Model ________________________ Year ____________ Vehicle identification number (VIN)/ / / / / / / / / / / / / / / / / / Name/address of selling/leasing dealer___________________________________________________________ __________________________________________________________________________________________ Vehicle was: ____ purchased or ____ leased (check one) Date of delivery ________________ Odometer reading on delivery date ___________ Odometer reading at first repair visit for defect____________ Date vehicle registered in GA if bought/leased in another state ________________ If applicable, date ___________ and odometer reading _____________ on 30th day vehicle was out of service for repair; or date final repair attempt request was received by manufacturer _____________________ Note to consumer: If the manufacturer designated a reasonably accessible repair facility within seven (7) days from the receipt of your final repair attempt request, please list the following: Date of final repair __________________ and name of the facility where the final repair attempt took place: _________________________________________________________________________________________ Was the defect corrected on the final repair attempt? ______________ Yes _______________ No *************************************************************************************** I am requesting that you ____ replace or ____ repurchase (check one) the vehicle described above within twenty (20) days from the receipt of this notice. My contact information is: Consumer name ____________________________________________ Home phone ___________________ Street address _____________________________________________ City/State/Zip _____________________________________________ Consumer signature ________________________________________ Cell phone ____________________ Work phone____________________ Today's date ___________________ Instructions to consumer: Remember to make a copy for your records and send the original by overnight mail delivery or certified mail, return receipt requested, to the manufacturer at the address provided in your owner's manual. If your vehicle is a motor home, you must send notices to all known manufacturers. Also, for our records, please send us a copy at the address listed on the first page, or fax it to us at: 404-656-3569. B American LegalNet, Inc. www.FormsWorkFlow.com
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