Mv2694 - Motor Vehicle Lemon Law Claim printable pdf download

2014 Wis. Act 101 requires form MV2691 to be used to make a lemon law replacement

vehicle/refund demand for a vehicle purchased on or after March 1, 2014.

For vehicles purchased BEFORE

Motor Vehicle Lemon Law Claim

March 1, 2014 use this form MV2694.

Demand for relief under s. 218.0171, Wisconsin Statutes

Wisconsin Department of Transportation

MV2694

5/2014

Print & complete, or click on first line. Tab to next field. Enter only as much text as will fit on a line.

Pursuant to the Wisconsin Lemon Law, I am notifying _____________________________________of the following:

(check one)

(manufacturer)

My vehicle has been made available for repair at least 4 times for the same defect during its

first year of warranty.

My vehicle has been out of service at least 30 days because of one or more defects during its

first year of warranty.

Vehicle Make _____________ Model ________________ Year ________ VIN (17 digits) ________________________

Name and city/state of selling or leasing dealer or leasing company ___________________________________________

Date of vehicle delivery ______________________________ Today’s date ____________________________________

Name of financial institution that financed/leased vehicle ______________________ Loan account # ________________

By providing this information, I authorize the manufacturer to contact this financial institution for financing

information needed to calculate a refund. Authorization expires 35 days after the date of this form.

— See back for vehicle defect and repair information —

My vehicle has a defect(s) that substantially impairs its use, value or safety. I demand that the manufacturer

give me one of the following within 30 days:

(check one)

A comparable new vehicle in accordance with the Lemon Law, plus collateral costs

A refund calculated in accordance with the Lemon Law, plus collateral costs

Description of collateral costs I have incurred in connection with vehicle repairs. (Examples include alternative

transportation, towing costs.) ________________________________________________________________________

________________________________________________________________________________________________

Description of non-removable options that have been added to my vehicle after the sale, but not included in the vehicle

purchase price. (Examples include sunroof, rustproofing, roof rack, pinstriping, etc.)_____________________________

________________________________________________________________________________________________

Description of missing equipment or serious unrepaired vehicle damage. (Do not include normal wear and tear such as

minor dents, scratches, pitted glass, soiled carpets, minor stains or tears.)_____________________________________

________________________________________________________________________________________________

I offer to return my vehicle and transfer title after the manufacturer meets my demand for Lemon Law relief.

Owner name __________________________________ Co-owner (if any) ____________________________________

Address _________________________________________________________________________________________

Home phone (optional) __________________________ Work phone (optional) _________________________________

Fax (optional) _________________________________ Owner signature _____________________________________

DO NOT USE THIS FORM FOR VEHICLES PURCHASED ON OR AFTER MARCH 1, 2014.

Obtain form MV2691 Motor Vehicle Lemon Law Notice and Nonconformity Report from

Mv2694 - Motor Vehicle Lemon Law Claim

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