Talk with a lemon law attorney who will let you know within 48 hours if you have a valid claim---no-charge, no obligation.

About Your Vehicle:

Vehicle Type:

Car

Recreational Vehicle

Boat

Motorcycle

ATV/Other

Make (Ford, Toyota, etc.):

Model (Mustang, Corolla, etc.):

Year:

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Other

Bought:

New    Used    Demo

Purchased or Leased:

Purchase Lease

Date of purchase or lease:

--Select Month-- January February March April May June July August September October November December --Select Day-- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Mileage at time of purchase:

Select mileage range 0 – 10,000 miles 10,000 – 20,000 miles 20,000+

Mileage now:

Select mileage range 0 – 10,000 miles 10,000 – 20,000 miles 20,000 – 30,000 miles 30,000 – 40,000 miles 40,000 – 50,000 miles 50,000 – 60,000 miles 60,000 – 70,000 miles 70,000 miles plus

Vehicle Problems:

Kinds of Problems and No. of Repair Attempts:

Engine/Transmission:

0 1 2 3 4+

Suspension/Steering or Brakes:

0 1 2 3 4+

Electrical System:

0 1 2 3 4+

Body/Paint/Interior:

0 1 2 3 4+

Heating/AC:

0 1 2 3 4+

Leaks or Noises:

0 1 2 3 4+

Other Problems? Tell us more:

How many days has the vehicle been in the shop:

Less than 30 days More than 30 days

How did you find us:

Select one... Google Yahoo MSN Alta Vista AOL Search Ask Other search Other web site Online ad or press release Print ad Referral Other

About You:

* Name:

Address:

City:

State:

Zip Code:

* Preferred Phone:

Fax:

Email:

What’s the best way to contact you?:

Phone E-mail

When is the best time to contact you?:

Mornings (8A – 12P) 

Afternoons (12P – 5P)

Evenings (After 5P)

All information provided to us shall remain confidential.

We will never sell, trade, or exchange email addresses or other information with third parties unless specifically authorized to do so by the client.