Anthony T. Ballato - Attorney and Counsellor At Law
Lemon Law Intake Form

You can view the current lemon laws, as stated by the New York Better Business Bureau, by clicking on either of the following links;

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required fields to complete form
Contact Information
Owner(s) Name(s):
Address 1 Address 2
City State
Zip Code

Telephone/E-mail Information
Home Phone
Work Phone
Fax
Current E-mail
Alternate Phone
Best time to call

Additional Information
How were you referred to the attorney

Dealer Information
Dealer
Dealer Address 1 Dealer Address 2
Dealer City Dealer State
Dealer Zip Code
Phone

Vehicle Information
Purchased: New Used Date of Purchase

Make Model
Model Year Current Milage
Purchase Price Milage at Delivery
Warranty
Dealer Options and After Market Equipment
 
Rental Fees Trade Ins
Allowance
Car Problems and Work Performed

Are any problems caused by after-market equipment? Yes No

If so, explain:

What date did you first report this problem(s) to the dealer:
What was the mileage at that time?
Were there a number of repair attempts for the same problem?

Has the problem been resolved? Yes No

Is the vehicle used for personal or business use?


Additional Comments

Anthony T. Ballato 5476 Merrick Road Massapequa, New York 11758 (516) 541-9080

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Copyright © 2005 Anthony T. Ballato, All Rights Reserved - Phone: (516) 541-9080
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Dislaimer: No attorney-client relationship exists nor shall be implied by any visits  to this website, or communications to this attorney. Nor shall any information or communications be privileged by this web site or sent via e-mail, therefore restrict same to direct communications with the attorney.  A prospective client must contact the attorney via telephone or an office appointment, and sign a written retainer before any attorney-client relationship may be created.  This firm reserves the right to decline any case or matter.  The attorney does not consent to and prohibits the service of process or filing of any papers, upon him and his firm via any electronic or digital means.