(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
cumulative days to repair one or more malfunctions
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
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)
previous repairs: __________________________________________________
Consumer _____________________ Home phone ( _____ )_______________
Address _____________________ Work phone ( _____ )_________________
_____________________ Signature __________________________________