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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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| Case Information: |
| Manufacturer | | |
| Model Year: | | |
| Model: | | |
| Purchase Date: | | |
| State where Purchased: | | |
| Current Mileage: | | |
| Purchase Mileage: | | |
| Dealer: | | |
| Warranty: | | |
| Type of Purchase: | | |
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| If new, please answer the following questions: |
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Did the seller represent directly or indirectly that your vehicle was a factory executive vehicle, executive vehicle, or demonstrator?
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Did the seller represent orally or in writing that your vehicle had not sustained accident damage?
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Did the seller obtain your signature on a contract that was not fully completed at the time of signing or which did not relfect accurately the negotiations and agreement between you and the seller?
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Did the seller increase the price of your vehicle after having accepted an order of purchase or a contract from you?
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Did the seller require or accept a deposit from you prior to entering into a binding contract for the sale of your vehicle without giving you a written receipt stating how long the seller will hold the vehicle from other sale and upon what conditions the deposit is refundable or nonrefundable?
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Did the seller deliver the vehicle to you or take possession of your trade in without already having secured financing?
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Did the seller increase the price of your vehicle to cover negative equity from a previous vehicle?
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Did the seller make any other misrepresentations or omissions in connection with your purchase?
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If so, please provided the details:
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| If used, please answer the following questions: |
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Did the seller misrepresent the mechanical condition of your vehicle?
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Did the seller misrepresent the terms of any warranty offered in connection with the purchase of your vehicle?
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Did the seller represent that your vehicle was sold with a warranty when the vehicle was sold without any warranty, or, fail to disclose prior to sale that your vehicle was being sold without any warranty?
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Did the seller represent orally or in writing that your vehicle had not sustained accident damage?
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Did the seller misrepresent the previous usage or status of your vehicle (e.g. did the seller fail to disclose the used vehicle was a rental car, one owner vehicle, etc.?)
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Did the seller obtain your signature on a contract that was not fully completed at the time of signing or which did not reflect accurately the negotiations and agreement between you and the seller?
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Did the seller require or accept a deposit from you prior to entering into a binding contract for the sale of your vehicle without giving you a written receipt stating how long the seller will hold the vehicle from other sale, the amount of the deposit, and whether and upon what conditions the deposit is refundable or nonrefundable?
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Did the seller alter or change the odometer mileage of your vehicle?
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Did the seller fail to disclose to you the actual year and model of your vehicle?
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Did the seller increase the price of your vehicle after having accepted an order of purchase or a contract from you?
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Did the seller deliver the vehicle to you or take possession of your trade-in without already having secured financing?
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Did the seller increase the price of your vehicle to cover negative equity from a previous vehicle?
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Did the seller make any other misrepresentations or omissions in connection with your purchase?
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If so, please provide the details:
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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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