Follow the steps to complete the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the customer information section. This includes providing the full name of the titled owner, mailing address, city, state, zip code, and contact details such as day phone, evening phone, fax, email address, and cell phone.
3. In the vehicle information section, enter the name(s) that appear on the vehicle title. Indicate whether the vehicle is leased by checking the appropriate box (Yes or No).
4. Clarify if the vehicle is currently in your possession by selecting Yes or No. Specify if the vehicle was purchased used by checking the relevant box.
5. Provide the delivery date, and if applicable, include the lessor’s name and address. Additionally, indicate the percentage of use of the vehicle for business purposes and the number of vehicles owned or leased by the business.
6. Fill in the vehicle make, model, year, current mileage, and the Vehicle Identification Number (VIN). Include the name and address of the selling dealer and the dominant servicing dealer.
7. In the vehicle problems section, clearly list the problems encountered with the vehicle. Attach legible copies of applicable repair orders and supporting documents.
8. Identify the dealer(s) that have attempted repairs, including their locations, repair order numbers, and the repair dates along with mileage.
9. Answer whether the vehicle has been involved in an accident by checking Yes or No. If Yes, provide the date of the accident and specify the damaged area.
10. Clearly articulate the resolution sought regarding the issue by providing details in the designated area.
11. Review all filled fields for accuracy. Once confirmed, you may either save changes, download the form, print it, or share it as needed.

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