Clone of Ford Intake Form

1

What year is your Mercedes?* This field is required.We do not handle cases involving vehicles older than 2020 at this time.

2020

2021

2022

2023

2024

2025

2026

2

What is the model of your Mercedes?* This field is required.

3

When did you purchase your Mercedes?* This field is required.

4

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

New

Certified pre-owned

5

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

6

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

1 time

2 times

3 times

4 or more times

7

First Name* This field is required.

8

Last Name* This field is required.

9

Email* This field is required.

example@example.com

10

Phone Number* This field is required.

Please enter a valid phone number.

11

How would you like to be contacted about your potential case?* This field is required.

Phone call

Email

12

How did you hear about us?* This field is required.If you were referred by an attorney, please provide their full name below so we can thank them!