Texas Lemon Law Lawyers & Louisiana Lemon Law Attorneys

Principal Office
111 Park West Drive
Scott, Louisiana 70583
(877) 536-6628 Phone
(337) 262-0679 Fax
Texas Office
3333 Lee Parkway
Suite 600
Dallas, Texas 75219
(214) 665-9545 Phone
(214) 665-9546 Fax

Case Evaluation

Tell Us About Yourself

First Name:				Last Name:
Address:
City:				State:
Zip:				Phone#:
Work Phone:				Cell/Pager:
E-Mail:
How may we contact you?
If other, please explain:

What is the best time of day to reach you?

Daytime
(9a-6p)

Evening
(6p-8p)

Tell Us About Your Vehicle

Year:		Make:		Model:
Vehicle Identification Number (VIN)

Vehicle was:

Purchased

Leased

Date Purchased

month

year

Approximate Mileage
Purchase Status	New	Used	Demo
If vehicle is used please enter mileage at time of purchase:
Type of Warranty:
In the spaces provided, please list the SYMPTOMS that you have experienced with your vehicle and the number of trips to the dealer for each symptom (whether documented or not).
Symptom				# of Repair Attempts
	Engine, Transmission
	Suspension, Steering & Brakes
	Electrical System
	Body, Paint & Interior
	Heating / AC
	Leaks
	Noises
	Other
Please provide any additional information (optional) :

Total number of times vehicle has been in for repair:
Total number of days vehicle has been in service:
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Texas Lemon Law Attorneys / Louisiana Lemon Law Lawyers
©Dalton & Associates, L.L.C.

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