Car Lemon Free Case Review


Contact Information:
*First Name:
*Last Name:
Address 1:
Address 2:
*City:
*State:			*Zip:
*Email:
*First Phone:
Second Phone:
Third Phone:
Comments:
Referred By:
If Other:


Vehicle Information:
Manufacturer:
Model Year:
Model:
Purchase Date:
Type of Purchase:
State of Purchase :
Current Mileage:
Purchase Mileage:
Dealer:
Warranty:

Repair Information:
			Total Number of Repairs
			Total Number of Days in the Shop
			- Brakes, Steering or Suspension
			- Engine or Transmission
			- Electrical System
			- Heating or Air Conditioning
			- Fluid Leaks
			- Unusual Noises
			- Body, Paint or Interior
			- Other
Additional Information:

Other Vehicle Concerns:
			Do you suspect the Odometer may have been altered prior to your purchase?
			Do you think the Vehicle may have been in an accident prior to your purchase?
			List any other concerns related to the purchase or repair of your vehicle.

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