Fillable Instructions for Completing the Application for Used Car (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Instructions for Completing the Application for Used Car (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Thank you for contacting the New Jersey Lemon Law Unit. The Used Car Lemon Law requires dealers to provide
warranties with minimum durations to purchasers of certain used motor vehicles. If the dealer fails to correct a
defective item which is covered under the warranty, you may be eligible for relief. To apply, please complete the
enclosed application, along with the Division of Consumer Affairs complaint form, and send them with supporting
documentation to:
Division of Consumer Affairs
Used Car Lemon Law Unit
124 Halsey Street, 7th Floor
P.O. Box 45026
Newark, NJ 07101
Please be certain that your used motor vehicle meets all of the requirements under the Used Car Lemon Law
before submitting your application. If you have any questions after reviewing the enclosed paperwork, please
contact the Lemon Law Unit at (973) 504-6226 and someone will be glad to assist you.
Sincerely,
Used Car Lemon Law Unit
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
Ofce of Consumer Protection
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
WEbsitE: www.state.nj.us/lps/ca/home.htm
Instructions for Completing the Application
for Used Car Lemon Law Dispute Resolution
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:_________________________________________ BusIness: ______________________________________
aDDress:_______________________________________ aDDress:_______________________________________
CIty:__________________________________________ CIty:__________________________________________
state:_______________________ ZIP:____________ state:_______________________ ZIP:____________
HometelePHonenumBer:_________________________ telePHonenumBer(1):___________________________
(include area code) (include area code)
WorktelePHonenumBer:_________________________ telePHonenumBer(2):___________________________
(include area code) (include area code)
e-maIlaDDress:________________________________
1. Vehicle Information
Make ______________________________ Model _________________________________ Year ________________
Date of Purchase _____________________ Purchase Price __________________________
2. Vehicle Identication Number (VIN) ________________________________________________
3. Mileage, on date of purchase: _____________________ Mileage, at present: ______________________
4. a. Is your vehicle normally used for personal, family or household purposes? Yes No
b. Is your vehicle normally used for commercial purposes? Yes No
5. Does the material defect substantially impair the use, value or safety of the vehicle? Yes No
6. 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
7. Warranty Information (Please check all that apply.)
I purchased the vehicle AS IS.
I was given a limited dealer warranty at no extra charge.
Duration of warranty: 30 days/1,000 miles 60 days/2,000 miles
90 days/3,000 miles Other ________________________
I purchased an extended service contract. (Please provide a copy.)
Warranty Company: ___________________________________________________________________________________
Street Address: ___________________________ City: ____________________ State: ______ ZIP: ___________
Telephone Number (include area code): ___________________________________
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
Ofce of Consumer Protection
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
Used Car Lemon Law Dispute Resolution Application
8. a. If the vehicle’s mileage was more than 60,000 at the time of purchase, did you waive the warranty? Yes No
b. Did you sign a waiver form? Yes No If “Yes,” please provide a copy of the waiver.
9. Repair Information (Use additional sheets of paper if needed.)
What is the malfunction or material defect you are claiming? ______________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
10. a. Did you notify the dealer of the problem described in question #9? Yes No
b. If “Yes,” on what date? __________________________ What was the mileage at that time? ______________________
11. Were three (3) or more repair attempts made for the same problem? Yes No
12. Were all three (3) repair attempts made within the warranty period? Yes No
13. Do any of the alleged defects still exist? Yes No
For each alleged defect:
Description of problem Date & Mileage of each repair attempt
a.
Date: ____________ Mileage _________________ 1
st
Attempt
Date: ____________ Mileage _________________ 2
nd
Attempt
Date: ____________ Mileage _________________ 3
rd
Attempt
b.
Date: ____________ Mileage _________________ 1
st
Attempt
Date: ____________ Mileage _________________ 2
nd
Attempt
Date: ____________ Mileage _________________ 3
rd
Attempt
c.
Date: ____________ Mileage _________________ 1
st
Attempt
Date: ____________ Mileage _________________ 2
nd
Attempt
Date: ____________ Mileage _________________ 3
rd
Attempt
14. a. Was the vehicle out of service for a total of 20 or more calendar days, due to repairs? Yes No
b. If “Yes,” how many days? ______________
c. List the dates below:
1. From ______________________________ to ___________________________ number of days ______________
2. From ______________________________ to ___________________________ number of days ______________
3. From ______________________________ to ___________________________ number of days ______________
15. a. Was the vehicle repaired by anyone other than the dealer or its agent? Yes No
b. If “Yes,” where?
Name: ______________________________________________________________________________________________
Street Address: ___________________________ City: __________________ State: _______ ZIP: ___________
County: _________________________________ Telephone Number (include area code): _________________________
16. Financial Information
_______________________________________________________________________________________
Street Address: ______________________________ City: _____________________ State: _________ ZIP: _____________
Account Number: ___________________________ Telephone Number (include area code): __________________________
Additional Information17.
Name of lienholder:
Yes NoHave you participated in any previous arbitration for the same problem(s) for which you are seeking relief?
_______________________________ Date of arbitration______________________
a. If “Yes,” what type of arbitration?
____________
b. Did you accept the decision? Yes No If “Yes,” please explain and give the current status:
_______________________________________________________________________________________________________
18. If an attorney is going to represent you, please provide the following information:
_____________________________________________ Firm Name: _______________________________________
Name:
________________________ City: _______________________ State:_________ ZIP: ___________
Street Address:
____________________________________ Telephone Number (include area code): _____________________
County:
knowledge.
I certify that the dealer has not yet given me a refund, and that all statements made in the complaint are true to the best of my
I certify that the foregoing statements made by me are true. I am aware that if any of the foregoing statements made by me are
willfully false, I am subject to punishment. I authorize the New Jersey Division of Consumer Affairs to send this complaint form to
the company or to the interested parties and to use the information in any way that is necessary.
_________________________________________________________ ___________________________
Signature Date
If you have not already done so, please attach clear and legible copies (do not send originals) of the following:
• All relevant evidence of repair attempts
° sales invoice
° purchase order
° nance contract (if nanced)
° vehicle registration
° repair receipts
° Used Car Buyer’s Guide (window sticker)
3/28/14
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Instructions for Completing the Application for Used Car (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Completed 21 July 2020

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