Jeep Hybrid Battery Fire, Failure Claims

Jeep Hybrid Battery Questionnaire

Want to know more about your legal options regarding your Jeep Hybrid vehicle? Provide us the following information and we will look into it!
Note: If there is more than one person on the title, please make sure both names are entered into the form. If you have or formerly owned more than one vehicle that fits this mass action effort, be sure to fill out the form below for EACH of your vehicles.
Name*

First NameLast Name
Co-Owner Name if applicable

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number*

Area CodePhone Number
Vehicle Model/Year*
VIN Number*
Purchased or Leased?*
Purchased New or Used?*
Date Purchased/Leased*

MonthDayYear
Purchase Price*
State Purchased*
Where was the Vehicle Purchased/Leased?*
Seller's Name
Still Own?*
If no, how did you dispose of the Vehicle?
If sold, Date of Sale?

MonthDayYear
If sold, Value received for sale?
If sold, mileage at the time of sale?
Current Mileage of Vehicle*
Battery Replaced?*
Number of Battery Replacements*
Has the vehicle experienced a fire?*
Did you receive a recall notice related to your vehicle?*
If yes, when?
Did your vehicle receive any recall repair?*
If yes, when and what was done?
If yes, how many days was the vehicle out of service?
BY SUBMITTING THIS FORM YOU AGREE TO THE TERMS AND CONDITIONS LINKED HERE
Should be Empty:

Jeep Hybrid Battery Questionnaire