Lemon Law Intake Form
Contact Number
"Before we get started, please keep in mind we do NOT give any type of legal advice. We only bring lawsuits."
**Wait for a response. **
"Thank you for your time. Unfortunately, there's not much we can do at this time but if you do change your mind, please do not hesitate to contact us."
IF THE ANSWER IS NO, READ THIS.
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Name of Person Doing the Intake
Date
-
Month
-
Day
Year
Date
Client Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Preferred Language:
Gender
Male
Female
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Employment Details
Occupation
For how long?
Race/Ethnicity you identify yourself with:
Nationality
Employer's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Any limitations on contacting you (Email not secure? Cell phone not secure? Etc.)
Driver’s State/License#_
Social Security #
Educational Background
Served in the Armed Forces
Civil Status
If you have children, how many?
Whom the children live with?
What, if there's any medications you take
Name of Significant Other
Relationship to you
Living in the same address?
How Long?
Contact Number (Significant Other)
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Lemon Law Form
What Car Problem are you having?
Did your car problem start under warranty?
How many times have you taken your car do the dealership for repair?
WHat year is your car?
WHat's the maker and model of your car?
Did you get your car new or used?
In what state did you get your car from?
COMMENTS THAT MAY BE OF VALUE TO YOUR CASE
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