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MOTOR VEHICLE DEFECT NOTIFICATION

(Please print clearly in ink)

Pursuant to the Iowa Lemon Law, notice is given to the manufacturer as follows:
(check all that apply)

____ The vehicle has been out of service at least 20 cumulative days to repair one or more malfunctions or conditions that cause the vehicle not to conform to the warranty.

____ Three or more repair attempts have been made to repair the same defect or condition.

____ The vehicle has been in the shop one time by reason of a defect likely to cause death or substantial bodily injury.

Description of continuing defect(s) or condition(s):

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

(Note To The Manufacturer: this may not be a complete description; the manufacturer should ascertain all appropriate information).

I am requesting that you make a final attempt to correct the continuing substantial defect(s) or condition(s).

Veh. Make ___________________ Model _______________ Year __________

Vehicle Identification Number ___________________________________

Name and City/State of selling dealer or leasing co. __________

________________________________________________________________

Date of Delivery _________ Odometer reading at delivery _______

Today's date _____________ Current odometer reading _________

Name and City/State of authorized service agent(s) attempting

previous repairs: __________________________________________________

________________________________________________________________

________________________________________________________________

Consumer _____________________ Home phone ( _____ )_______________

Address _____________________ Work phone ( _____ )_________________

_____________________ Signature __________________________________