Intake Form

1

What year is your vehicle?* This field is required.We do not handle cases involving vehicles older than 2017 at this time.

2017

2018

2019

2020

2021

2022

2

What is the make and model of your vehicle?* This field is required.

3

Did you purchase the vehicle in California?* This field is required.We can only handle cases involving vehicles purchased in California.

YESNO

4

When did you purchase the vehicle?* This field is required.

5

Was your vehicle purchased:* This field is required.We are only handling cases involving new or certified pre-owned vehicles at this time.

New

Certified pre-owned

6

What problems have you had with your vehicle?* This field is required.

7

How many times have you taken your vehicle in for warranty repairs?* This field is required.

1 time

2 times

3 times

4 or more times

8

First Name* This field is required.

9

Last Name* This field is required.

10

Email* This field is required.

example@example.com

11

Phone Number* This field is required.

Please enter a valid phone number.