Potential Client Intake Questionnaire

Please fill out our intake questionnaire as completely as possible. One of our attorneys will contact you in the event your case can continue.

Today's Date (required)

Referred by

Did you purchase the vehicle in California? (required)

Name of Person on contract (required)

Name of Co-Signer

Main Phone # (required)

Email (required)

Date of Purchase (required)

Make (required)

Model (required)

Vehicle Year (required)

Mileage at Purchase (required)

Vehicle ID Number (VIN) (required)

Name of Car Dealer (required)

Address of Dealer (required)

Direct Loan or went thru Dealer (required)

Have you re-financed vehicle?

Name of Finance Company

Did you have a Trade-in? (required)

Did Trade-in have a Lien Balance prior to trade in? (required)

If yes, Please contact the trade-in bank and indicate the date the trade-in was paid off and for what amount.

Are you still making monthly payments on the trade-in vehicle?

Did you make a down payment? (required)

Down payment amount? (required)

Method of Payment (required)
CashCheckCredit CardOther

If by Check(s), Did you Post Date it?

What is Post Date(s)? (required)

If more than one down payment was required, list DATES of payments and AMOUNTS

Have you started making monthly payments for the vehicle? (required)

Monthly Payment Amount

How many monthly payments have been made?

Are your payments current? (required)

Do you still have possession of the vehicle? (required)

If no, please state reason:

Is the vehicle operational? (required)

Current Mileage (required)