(1) The consumer shall file a request for arbitration on a form prescribed by the department along with a filing fee of $50. The fee shall be refunded if the department determines the request for arbitration does not allege a warranty violation. The date of the receipt by the department of the completed form and fee shall be considered the filing date of the request.

(2) The consumer shall be required to provide the information relevant to the resolution of the dispute on the request for arbitration form. The information shall include, but not be limited to, the following:

(a) the name, address and telephone number of the consumer;

(b) the name, address and telephone number of the consumer's legal counsel, if applicable and known;

(c) vehicle information, including the date of purchase and date of delivery of the vehicle, the make, model and manufacturer of the vehicle, the vehicle identification number, present mileage and whether the vehicle was new or used at the time of purchase;

(d) all financial information related to the purchase and/or nonconformity(ies) ;

(e) the name and address of the selling dealership;

(f) the name and address of the servicing dealership(s) or facility(ies) ;

(g) information regarding the nonconformity(ies) , including:

(i) the nature of the nonconformity(ies) ;

(ii) the date and mileage when the nonconformity(ies) first occurred;

(iii) the date the nonconformity(ies) was (were) first reported to the dealer or manufacturer;

(iv) the dealer or manufacturer;

(v) the mileage when the nonconformity(ies) was (were) so reported;

(vi) the dates on which the car was at the dealership for repair;

(vii) the total number of days the vehicle was at the dealership by reason of repair since the purchase date; and

(viii) the circumstances concerning any refusal of service by the dealer, if applicable.

(h) name(s) , date(s) and the natur e of any and all oral or written communication with the manufacturer, selling or servicing dealership(s) or facility regarding the dispute;

(i) a statement regarding the consumer's assessment of what actions would constitute a fair resolution of the dispute;

(j) a statement regarding the consumer chosen form of arbitration hearing, whether oral or documentary;

(k) a copy of any and all warranties, including extended warranties, sales contracts and other relevant documents;

(l) copies of any and all correspondence between the consumer and the manufacturer or its representative(s) , if available; and

(m) copies of any and all service orders.

(3) The consumer's request for arbitration shall further include an agreement to arbitrate, which shall be signed by the consumer.