Motor Vehicle Defects Contact Form

Name

Email Address

Phone Number

What are the year, make, and model of the vehicle in question?

How did the accident occur?

What were the facts of the accident? Speed, conditions, other vehicles etc.

Were you found to have contributed to the accident in any way?
Yes  No 

Did the vehicle or some part or system of the vehicle fail during the accident?

Do you believe the part or system of the vehicle that failed was defective?

Has that part or system ever been serviced? Do you know if it has ever been recalled? Where is the vehicle or vehicle part now?

Where is the vehicle or vehicle part now?

Has anyone worked on your vehicle or vehicle part since the malfunction/accident?
Yes  No 

Did you experience similar difficulties with the car prior to the accident?
Yes  No 

Do you know what caused the problem?
Yes  No 

Were you ever warned in writing or otherwise regarding this problem?
Yes  No 

What physical or emotional harm did you suffer because of the accident or because of the defective vehicle or vehicle part?

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