Call: (713) 942-0808 |  111 Congress, Ste 400 - Austin, Texas 78701

Tell Us About It

Contact Information
First Name
Last Name
Home Phone
  Work Phone
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     Model  
Vehicle was: Purchased Leased
Date Purchased     Year  
Current Mileage
This vehicle was purchased/leased:  
  New     Used     Demo
Approx. Mileage at purchase (if vehicle is used)
Type of 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.
(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.  
2.     2.     2.  
3.     3.     3.  
4.     4.     4.  
Please provide any additional information you'd like to add:
How did you hear about our website?  
If 'Other', please indicate the name of the website or search engine