Indianapolis Lemon Law Lawyer Robert Duff Home
Contact Lebanon, Indiana Car Lemon Attorney Robert Duff
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Lemon Law Intake Form
Lemon Law Intake Form
Contact Information:
Name:*
Email:
Phone Number:
Alternate Phone Number: (Optional)
Address:
City:
State:
ZIP:
How did you hear about Mr. Duff?
Vehicle Information:
ABOUT YOUR VEHICLE:
Year:
Make:
Model:
Date of Purchase (month/date/year):
Purchase Dealer name:
Purchase Dealer location:
Is the vehicle you purchased:
New?
Used?
What is the vehicle's current mileage?
Was the vehicle purchased through any sort of discount program offered by the manufacturer (i.e., employee discount, etc)?
Yes
No
Do you use this car for business or personal use?
Business
Personal
If Business use, what percentage of total mileage? (Commuting is NOT business use.)
How much do you currently owe on the loan on this vehicle?
Vehicle Problems:
ABOUT YOUR PROBLEMS:
How many times has your vehicle been in the dealership for repair?
When was the last time your vehicle was in the dealership for repair?
Does the defect still exist?
Yes
No
How many days excluding Sundays and holidays has your vehicle been out of service because of repair work?
Do you have a repair order for every repair attempt?
Yes
No
Please list any significant problem(s) that currently exists with your vehicle for which you have 4 or more repair orders:
Any communication with the manufacturer?
Yes
No
Written letter?
Yes
No
Inspection by factory rep?
Yes
No
Have you demanded a refund?
Yes
No
Additional Comments:
Privacy Notice: Your privacy is very important to us. We will not sell your personal information to anyone for any purpose. Your personal information is collected solely for the purposes of evaluating your potential claim, and then handling your claim if we agree to represent you.
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