Tell Us About It Contact Information First Name Last Name Address City   State   Zip Home Phone   Work Phone Cell/Pager   Fax Email Address How would you like us to contact you? Email Home Phone Work Phone Other If 'Other', please explain below When would you like to be contacted? Daytime Evening Vehicle Information Year     Make   Select Make Acura Audi BMW Buick Cadillac Chevrolet Chrysler Daewoo Dodge Eagle Ford Hyundai Infiniti Jaguar Kia Lexus Lincoln Mazda Mercedes Mercury Mitsubishi Nissan Oldsmobile Plymouth Pontiac Porsche Saab Saturn Subaru Suzuki Toyota Volkswagon Volvo   Model   Vehicle was: Purchased Leased Date Purchased   Select Month January February March April May June July August September October November December   Year   Current Mileage This vehicle was purchased/leased:     New     Used     Demo Approx. Mileage at purchase (if vehicle is used) Type of Warranty:   Select One New Vehicle Warranty Extended Warranty/Service Contract No Warranty   Repair History Defects and Nonconformities In the spaces provided , please list the SYMPTOMS that you have experienced with your vehicle, the number of trips to the dealer for each symptom (whether documented or not), and the appropriate date(s) when the vehicle was inspected and/or repaired for each symptom.     Symptoms (Defects & Nonconformities)       # of Trips to Dealer       Dates in Repair Shop (_/_/_) 1.     1.     1.   2.     2.     2.   3.     3.     3.   4.     4.     4.   5.     5.     5.   6.     6.     6.   Total Number of Repair/Work Orders in your possession:   Approximate Total number of CALENDAR DAYS vehicle has been out of service and/or in the repair shop:     Can You List 4 Repair Attempts For The Same Complaint? (if you do not have four identical complaints, just list what you have)     Date       Problem       Resolution 1.     1.     1.   Repair Status Repaired Not repaired Repair pending 2.     2.     2.   Repair Status Repaired Not repaired Repair pending 3.     3.     3.   Repair Status Repaired Not repaired Repair pending 4.     4.     4.   Repair Status Repaired Not repaired Repair pending   Please provide any additional information you'd like to add:   How did you hear about our website?   Select One Yahoo MSN Google Lemon Law America Other Search Engine/Website If 'Other', please indicate the name of the website or search engine