Form 1: Registrant/Contact Information

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Registration System

Note:

This form (Form 1 of the Registration System) collects information about the “Registrant”. The Registrant is the contact person for the Registration.
The next form (Form 2 of the Registration System) collects information about a recalled vehicle and the recalled vehicle's registered owner(s). You will need the recalled vehicle's VIN, the vehicle ownership registration, and the odometer reading in order to complete Form 2. If you do not have this information available, please complete Form 1 of the registration. You may return and complete Form 2 when you have collected this information.
Please note that a separate Form 2 is required for each recalled vehicle you are registering.
Although we use the term "Class Member" for the recalled vehicle's registered owner(s), only the court may determine who is a “Class Member”.
Information marked with an asterisk(*) is required.
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New Registrant Contact Information

Choose a login name and password

Please enter the answer to the equation pictured to the right to verify this is not an automated process.*

Username*

TIP: Avoid using any personally identifiable information when creating your username. This includes your first or last name or your birthdate.

Password*

Confirm Password*

1. Registrant's name

First Name*

Middle Name

Last Name/Entity Name*

2. Registrant's current mailing address

Line 1*

Line 2

Line 3

City*

Province or State*

Postal Code or Zip Code*

Country*

3. Registrant's e-mail address

E-Mail Address*

4. Additional contact information (at least one of the following must be provided) *

Country Area Code Number Ext.

Primary Phone Number

Alternate Phone Number

Fax Number

5. Security question

Choose one of the questions for security purposes*

The answer to the security question*

* required fields

System Login

Form 1: Registrant/Contact Information

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