Your Information

You may change your telephone number or move and forget to tell us! Please provide us with the name, address and phone number of an emergency contact that we can reach out to if we are unable to reach you. We will always try to reach you first at the contact information provided above.

Vehicle Information

Year of Vehicle

Select an Option 2022 2021 2020 2019 2018

Make and Model of the Vehicle

What is the VIN?

How many miles are on the vehicle now?

Purchase/Lease Information

Did you purchase the vehicle new or used?

New

Used

Did you purchase or lease the vehicle?

Purchase - Cash

Purchase - Finance

Lease

Purchase Date:

Where was the vehicle purchased?

Did you test drive the vehicle before purchasing/leasing it?

Yes

If yes, please describe any issues you experienced during the test drive.

No

What was the total cost of the vehicle?

In what state was the vehicle purchased?

In what state is the vehicle registered?

How many miles were on the vehicle at purchase?

What are the warranty terms (i.e.. 3 years / 36,000 miles)?

Did you purchase an extended warranty?

Yes

Describe the extended warranty:

No

Defects and Conditions In the Vehicle

Please describe the issues you have had with the vehicle.

When did you first take the vehicle back to a dealership to report an issue with the vehicle?

What was the mileage during this first visit?

How many times have you taken the vehicle back for the issues noted above?

How many days has the vehicle been out of service?

Please list all dealerships who have performed any of the repairs made to the vehicle.

How have these issues affected your use of the vehicle?

How have these issues affected your safety in the vehicle?

Have you tried to trade the vehicle in?

Yes

If yes, please describe.

No

Have you performed any work on the vehicle?

Yes

If yes, describe.

No

Has anyone other than an authorized dealership or you made any repairs to the vehicle?

Yes

If yes, describe.

No

Has the vehicle been in any accidents?

Yes

If yes, describe.

No

Where do you take the vehicle for routine maintenance?

Is there anything else you would like to share about the vehicle or the issues you have been experiencing?

Documents Needed

Please attach your purchase documents.

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Please attach your vehicle registration.

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Please attach your repair invoices.

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Please attach any notes or other relevant documents.

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Just a few more questions...

How did you hear about our firm?

Online

Where did you find us online?

Word of Mouth / Friend

Who can we thank for referring you?

Other

Please describe how you found us.

Please identify the name of the person completing this form.

Acknowledgement and Acceptance

I acknowledge that I have read and hereby accept the above privacy policy regarding use of my personal information.

That is it!