Lemon Law Assist Website Intake

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Lemon Law Assist Website Intake

Complete the short intake below to find out if you qualify for a replacement car, refund or cash $$ settlement. Are you ready?

1
What car problem are you having?
Transmission
Engine
Electrical
Brake
Power Steering
Recall
Other Issue...
2
Did your car problem start while your car under warranty?* This field is required.
YESNO
3
How many times have you taken your car to the dealership for repair?* This field is required.
0
1
2
3+
4
What year is your car?* This field is required.
2021
2020
2019
2018
2017
2016
2015 or older
5
What's the Make and Model of your car?* This field is required.For example, Chevy Silverado
6
Did you get your car NEW or USED?* This field is required.
USEDNEW
7
In what state did you get your car from?* This field is required.
8
What's your name?* This field is required.
First Name
Last Name
9
What's your email?* This field is required.
example@example.com
10
What's the best phone number to reach you directly?* This field is required.
11
What's the best way to reach you to talk to you about your car?* This field is required.
Phone Call
Text
12
When is the best time to reach you?* This field is required.
In the mornings
During work hours (9 AM to 5 PM)
After work hours (after 5 PM)
Should be Empty:

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