LexisNexis | Questionaire

Dear Attorney, I am supplying you the following below information concerning my Toyota vehicle in order that you may evaluate whether or not I have a claim against Toyota. I understand that until I have entered into a contractual arrangement with you there is no obligation on your part to pursue a case for me. I further understand that you may need to associate counsel in my state in order to pursue the case. I understand that there is no attorney fee owed by me to you for reviewing this questionnaire and evaluating my potential case. By submitting this document to you I accept the terms of the evaluation.. * Denotes required field
1. Contact and Vehicle Information
* Name:
* Street Address:
* City:
* State:
* Zip Code:
* Phone:
Alternate Contact Number:
* E-Mail Address:
Year and Model of Vehicle:
Vehicle Identification Number:
2. I currently am the title holder of this vehicle:	Yes No
3. If I am not the current title holder I was the title folder from year to year.
4. How much did you pay for the vehicle?
5. Did you buy an extended warranty?	Yes No
6. Name & Address of the dealership that you are dealing with.	Dealership Name Street Address City, State Zip
7. Current status of the Toyota vehicle:
8. Date I purchased the Toyota vehicle:
9. Date I experienced oil gel problems:
(Please check the following that apply)	Blue smoke coming from exhaust pipe Check engine light coming on Oil gel residue noticed Engine stalled or seized
10. When did you first complain to TOYOTA about oil gel problems (even if you did not know at the time what the problem was) and who did you complain to. Explain as much as possible. VERY IMPORTANT.
11. I have made a claim through the class action pending in Louisiana:	Yes No
12. Please provide details of your answer to #11:
13. Please describe the efforts you made to have your engine repaired including conversations with Toyota:
14. Please describe how you have been monetarily harmed or damaged:
15. Please describe how you have been damaged other than monetarily (inconvenience, time spent trying to resolve the engine problem, loss of enjoyment of the vehicle, etc.):
16. Please describe any legal action you have pursued:
17. Please describe any misleading information you have received from Toyota or the Dealership:
18. Other information I think you should know:
**No representation is made that the quality of the legal services to be performed is greater than the quality of legal services to tbe perfomred by other lawyers.

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