1012 N. Bethlehem Pike
Suite #103, Box 9
Ambler, PA 1902
Telephone: (215) 278-6564
Toll Free: (855) 978-6564
Fax: (855) 777-0043
www.ginsburglawgroup.com
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Vehicle Information
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Make and Model of the Vehicle
What is the VIN?
How many miles are on the vehicle now?
Purchase/Lease Information
Did you purchase the vehicle new or used?
New
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Did you purchase or lease the vehicle?
Purchase - Cash
Purchase - Finance
Lease
Purchase Date:
Where was the vehicle purchased?
Did you test drive the vehicle before purchasing/leasing it?
Yes
If yes, please describe any issues you experienced during the test drive.
No
What was the total cost of the vehicle?
In what state was the vehicle purchased?
In what state is the vehicle registered?
How many miles were on the vehicle at purchase?
What are the warranty terms (i.e.. 3 years / 36,000 miles)?
Did you purchase an extended warranty?
Yes
Describe the extended warranty:
No
Defects and Conditions In the Vehicle
Please describe the issues you have had with the vehicle.
When did you first take the vehicle back to a dealership to report an issue with the vehicle?
What was the mileage during this first visit?
How many times have you taken the vehicle back for the issues noted above?
How many days has the vehicle been out of service?
Please list all dealerships who have performed any of the repairs made to the vehicle.
How have these issues affected your use of the vehicle?
How have these issues affected your safety in the vehicle?
Have you tried to trade the vehicle in?
Yes
If yes, please describe.
No
Have you performed any work on the vehicle?
Yes
If yes, describe.
No
Has anyone other than an authorized dealership or you made any repairs to the vehicle?
Yes
If yes, describe.
No
Has the vehicle been in any accidents?
Yes
If yes, describe.
No
Where do you take the vehicle for routine maintenance?
Is there anything else you would like to share about the vehicle or the issues you have been experiencing?
Documents Needed
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Just a few more questions...
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Online
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Who can we thank for referring you?
Other
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In the meantime, please feel free to contact us with any questions at 215-278-6564 or toll free at 855-978-6564.