Questionnaire

Lemon Law Questionnaire | Personal Injury Questionnaire

Questionnaire for Lemon Law Cases

Contact Details
Name:*
Address:
Home Phone:*
Cell Phone:
Work Phone:
Vehicle Details
Year:
Make: *
Model: *
Date Vehicle Purchased:
Miles on Vehicle
When Purchased:
At First Major Problem:
Current:
Repair Details
Approximate total number of days vehicle has been in for repairs:
List the major problems with vehicle which required repairs, and how many times the problem(s) has been repaired, or attempts have been made to repair:
Problem:		Times Repaired:
Problem:		Times Repaired:
Problem:		Times Repaired:
Problem:		Times Repaired:
If the vehicle is continuing to have problems, please state the problems:
When is the best time to reach you?
Please enter the text from the image: *

Phone: (661) 222-9929
Phone: (818) 904-6800
FAX: (661) 284-1811