Lemon Law Assist Website Intake

1

What car problem are you having?

Transmission

Engine

Electrical

Brake

Other Issue...

2

Did your car problem start while your car under warranty?

YESNO

3

How many times have you taken your car to the dealership for repair?* This field is required.

3+

2

1

0

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?

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

11

What's the best phone number to reach you directly?* This field is required.

12

What's the best way to reach you to talk to you about your car?

Phone Call

Text

13

When is the best time to reach you?

In the mornings

During work hours (9 AM to 5 PM)

After work hours (after 5 PM)

Other

14

Please verify that you are human* This field is required.