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Call: (713) 942-0808 | 111 Congress, Ste 400 - Austin, Texas 78701
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Vehicle Problem Assessment Sheet
If you would like us to see whether we can help with your vehicle complaint, please fill out the following "Vehicle Problem Assessment Sheet." When you have completed the form please press the submit button and someone will contact you by email.
DO NOT SUBMIT AN INQUIRY UNLESS YOUR TRANSACTION ORIGINATED IN TEXAS.
IF YOUR TRANSACTION OCCURRED OUTSIDE OF TEXAS NO RESPONSE WILL BE GIVEN.
IF YOUR TRANSACTION OCCURRED IN TEXAS BUT OUTSIDE OF THE HOUSTON AREA YOU MAY BE ASKED FOR ADDITIONAL INFORMATION.
IF YOUR TRANSACTION OCCURRED IN THE HOUSTON TEXAS AREA I WILL ATTEMPT TO RESPOND.
Thank You!
Vehicle Information
(Provide as much as possible)
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
Dealer Name
Dealer Address
City
State
Date Purchased
Select Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
Purchase Price
Mileage at purchase
<1000
<30000
<50000
>50000
This vehicle was purchased/leased:
new
used
demo
Current Mileage:
Contact Information
Your name
E-mail Address
Address
City
State
Zip
Home Phone
Work Phone
Pager
Fax
Problem Information
Please
check
all that apply to your situation.
Bad Car
Bad Dealer
Non-Disclosure of Prior Collision
Paid price Higher than Advertised
Non-Disclosure of Prior Flood
Problem with Extended Service Contract
Non-Disclosure of Prior Salvage/Branded Title
Problem with Credit Life/Disability Insurance
Non-Disclosure of Prior Lemon
No Title transferred
Motor Home
Spot Delivery
Are you from Texas or did your consumer transaction take place in Texas?
Yes
No
Dollar range of problem
Less than $1000
$1000-$5000
$5000+
If you would like to tell us a little more about your
problem, please explain below:
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