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| Contact Information: |
| *First Name: | | |
| *Last Name: | | |
| Address 1: | | |
| Address 2: | | |
| *City: | | |
| *State: |
*Zip: | |
| *Email: | | |
| *First Phone: | | | |
| Second Phone: | | | |
| Third Phone: | | | |
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| Referred By: | |
| If Other: | |
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| Vehicle Information: |
| RV Type: | | |
| Manufacturer: | | |
| Model Year: | | |
| Model: | | |
| Purchase Date: | | |
| Type of Purchase: | | |
| State where Purchased: | | |
| Current Mileage: | | |
| Purchase Mileage: | | |
| Dealer: | | |
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| Repair Information: |
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Total Number of Repairs
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Total Number of Days in the Shop
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- Engine/Chassis Batteries/Alternator
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- Brakes/Steering/Suspension/Axles
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- Interior/Exterior Fit & Finish
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- Coach Heating or Cooling System
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- Chassis Electrical System
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- Plumbing
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- Appliances
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- Frame
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- Slide Outs/Leveling System
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- Generators/Coach Batteries
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- Fluid Leaks
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How many miles have you spent driving to get repairs?
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Do you have any drivability issues (wandering, pulling) with your motorhome?
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If you have drivability problems are they current or prior problems?
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Are there gaps/air leaks in the body?
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If yes please describe:
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Are there any noises when you move about the motor home?
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If yes, please describe.
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Have you experienced any vibrations or shaking of the unit? | |
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If you have vibration or shaking, are they current or prior problems?
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Additional Information?
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List the states where repairs have been made.
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Do you have any other conerns related to the purchase or repair of your vehicle?
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Submitting this form does not establish an attorney/client relationship – that will be established only upon our mutual agreement and execution of an agreement. Weisberg & Meyers, LLC has attorneys admitted to practice in Arizona, California, Colorado, Florida, Illinois, New Mexico, Oklahoma, Oregon, Texas and Washington and works with a nationwide network of consumer advocates in all other states. Accordingly, inquiries/submissions may be referred to and services may be performed by other attorneys associated with Weisberg & Meyers, LLC. As such, information sent in a request for a brochure/information may not be kept confidential and may not be protected by the attorney/client privilege, however, any such information will not be disseminated in any way or for any purpose other than that stated above.
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