Select One Below: Documents Only Hearing In Person Oral Hearing Teleconference FOR NCDS USE CASE NUMBER: FCA US LLC Customer Claim Form CUSTOMER NAME AND ADDRESS Mr. Mrs. Ms.
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How to fill out the NCDS FCA US LLC Customer Claim Form online
Filling out the NCDS FCA US LLC Customer Claim Form online is a straightforward process designed to ensure your claim is accurately submitted. This guide provides step-by-step instructions on how to complete each part of the form effectively.
Follow the steps to accurately complete your claim form.
- Click 'Get Form' button to obtain the form and open it in the editor.
- Begin by entering your personal information in the 'Customer Name and Address' section. Select the appropriate title (Mr., Mrs., Ms.), and provide your first name, middle initial, last name, street address, city, state, zip code, and both day and evening phone numbers, along with your email address.
- Next, move to the 'Vehicle Information' section. Enter the name(s) that appear on the vehicle title, indicate whether it is a leased vehicle by selecting 'Yes' or 'No', and clarify if it was purchased used. Fill out the make, model, year, and current mileage of the vehicle. Don't forget to provide the Vehicle Identification Number (VIN), selling dealer and address, and primary servicing dealer information.
- In the 'Vehicle Problems' section, list the problems you are experiencing with the vehicle. Attach any relevant documents, such as repair orders, that support your claim. Document each dealer that has attempted repairs along with the corresponding dates, mileage, and repair order numbers.
- Indicate whether the problem currently exists by circling 'Yes' or 'No'. If the vehicle has been involved in an accident, provide the date of the accident and specify any damaged areas.
- Finally, outline the resolution you are seeking, such as repurchase or reimbursement. Once you have completed the form, sign and date it to confirm your submission.
- Return all copies of the form to the National Center for Dispute Settlement at the provided address or email it to the designated address.
Start completing your claim form online today to ensure your concerns are addressed promptly.
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