Phone: (310) 616-6422FAX: (310) 861-8923303 North Glenoaks Blvd. Suite 200Burbank, CA 91502 Free Case Evaluation Vehicle Year, Make and Model * Date Purchased * MM DD YYYY Current Mileage * What type of defect is the vehicle experiencing? (check all that apply) * Serious safety issue (brake failure, airbag light is on, stalls while driving, door doesn't shut properly, rear view camera freezes...) Lowered resale value (bad paint, water leaks into vehicle interior, climate control doesn't work, infotainment issues...) Minor but annoying issue (excessive wind noise, rattles, squeaks...) Other (describe) Was your vehicle under warranty when the problem(s) first occurred? * Yes No How many times has the dealer attempted to fix the problem(s)? * 1 2 3 4 5+ Vehicle Purchased * New Used (with warranty) Used (as is) Lease Demo Name * First Name Last Name Email * Telephone * (###) ### #### Thank you!
