Fill and Sign the Lemon Law Form

LEMON LAW QUESTIONNAIRE Name:       Address:       Phone:       (Home)       (Work)       (Cell) Fax:       E-mail:       Do you have any experience in car buying, car mechanical or body work, or in any other aspect of the car business? Yes No PURCHASING YOUR VEHICLE: Is the vehicle you purchased: New? Used? Did you purchase or lease the vehicle? Did you finance the vehicle? Yes No If yes, through whom?:       Was financing arranged through the selling dealer? Yes No Number and amount of payments made:       Date of last payment:       Cash down payment:       Rebate:       Whose name is on the title?       Name and address of co-signor, if applicable:       Vehicle Information: Make:       Model:       Model Year:       Current Mileage:       Mileage at Delivery:       Purchase Price:       Dealer Options:       Rental Fees:       Trade Ins:       Allowance:       Date of Purchase (month/date/year):       Salesperson:       Bought previous car from this dealer? Yes No Dealer Information: Dealer:       Dealer Address 1:       Dealer Address 2:       Dealer City:       Dealer State:       Dealer Zip Code:       Phone:       Please describe in detail any representations the dealer made about the condition of the car:       Did the dealer promise to perform maintenance or repairs? Yes No If yes, describe:       Did the dealer promise to deliver the title or any documents? Yes No Length of original manufacturer's warranty (excluding "extended warranties" or "service agreements"):       Did you purchase, in addition to the original manufacturer's warranty, an "extended warranty" or service contract? Yes No If yes, is it issued by the manufacturer or by an independent company? What is the length of this coverage?       Do you use this car for business or personal use? Business Personal Both If business use, what percentage of total mileage? (Commuting is NOT business use.)       % Please describe in detail any needs or requirements you made the dealer aware of:       Did you have an opportunity to inspect the car prior to sale? Yes No Did the dealer ask you to inspect the car? Yes No Did you inspect the car? Yes No If yes, describe inspection:       If no, why not?       Did you have an opportunity to drive the car prior to sale? Yes No Did you drive the car? Yes No If yes, describe drive:       If no, why not?       Describe anything you noticed in inspecting or driving the car that caused concern, suggested problems, etc.:       If you asked the salesperson about it, what was the salesperson's response?       CAR PROBLEMS AND WORK PERFORMED: Name and address of dealers who have repaired or attempted to repair your vehicle:                   How many times has your vehicle been in the repair shop for work?       Does the defect still exist? Yes No Do you have copies of all work orders for repairs performed on your vehicle? (you should get these from the dealers if possible) Yes No Please list any significant problem(s) that currently exists with your vehicle for which you have 3 or more repair orders: Any communication with the manufacturer? Yes No If yes, by written letter? Yes No Date received by manufacturer (month/date/year):       Inspection by factory rep? Yes No If yes, date (month/date/year):       Have you demanded a refund? Yes No Are any problems caused by after-market equipment? Yes No If yes, please explain:       What date did you first report this problem(s) to the dealer?       What was the mileage at that time?       Were there a number of repair attempts for the same problem?       Has the problem been resolved? Yes No Complaint / Defect # of repair attempts Does the problem still exist? Engine, Transmission       Yes No Brakes       Yes No Steering & Suspension       Yes No Electrical System       Yes No Body, Paint & Interior       Yes No Heating/ AC       Yes No Leaks       Yes No Noises       Yes No How many calendar days has your vehicle been out of service because of repair work?       Please provide any additional information you would like to add:       What remedy are you seeking? Cancel Sale Repair Replacement Money Damages, Amount $       Return for Trade-in What is the current mileage on the vehicle?       If the vehicle is not currently in your possession, please explain why:       LEMON CHECKLIST Please return this completed checklist along with your lemon law questionnaire and documents. Explain why you are not sending any of the itemized documents where indicated at the bottom of this page. PLEASE ORGANIZE YOUR DOCUMENTS IN DATE ORDER AND SEND PHOTOCOPIES, NOT YOUR ORIGINAL DOCUMENTS. MAKE SURE ALL COPIES CAN BE READ. REPAIR ORDERS WHICH ARE TYPICALLY VERY DIFFICULT TO READ, SO PLEASE COPY THESE AS DARK AS POSSIBLE. Purchase Agreement Credit Application Owner’s Manual Retail Installment Sales Contract/Loan Agreement Trade-In Documents Tax Receipt Odometer Statement Application for Title/Registration All Repair Orders Correspondence Arbitration Documents Advertisements, Brochures and Other Promotional Materials The original manufacturer's warranty (a booklet) Any extended warranty or service agreement (this is a separate document from your warranty) Magnuson-Moss Written Warranty Notes you may have made (i.e., during telephone calls) Copies of all DMV renewal notices and/or cancelled checks, reflecting the full amount of DMV fees paid on this vehicle from the time of purchase. Copies of all insurance premium statements paid on this vehicle from the time of purchase. Copies of any documents reflecting repairs or maintenance performed on this vehicle. Copies of any documents reflecting towing or storage charges you have incurred. Any documentation of lost wages incurred as a result of the problems with your vehicle. Documentation of any additional equipment which you have added to the vehicle. A statement of the number of days your vehicle has been out of service for repairs and for which you have not received a loaner vehicle or rented a vehicle. Copies of any documents reflecting charges for vehicles you have rented as a result of yours being out of service. A summary of the loan payments you have made on your vehicle (dates and amounts) together with the name, address, and telephone number of your lender, your account number and social security number. Also provide the current payoff amount (which you can get from the lender). A copy of your current registration. The completed "Lender Authorization" sheet (attached). Explanation of documents not included:       LENDER AUTHORIZATION Name of Lender:       Address of Lender:       Telephone Number of Lender:       Contact Person for Lender:       Name(s) on this Account:       Account Number:       Social Security Number:       I hereby authorize my above lender or lessor to release information on my above account including, but not limited to, payment history and payoff information, to my attorneys,       . Dated:       _______________________________ Signature _______________________________ Signature