Welcome to the Richard C. Dalton, LLC law offices. We need to gather some important information about your case. Click the start button below to begin.
Hi! What's your first name? *

Hello,  {{answer_22125619}}. Let's get your case set up. We'll start with some information about you: What is your last name? *

Enter your last name
{{answer_22125619}} {{answer_22125620}}.  Got it.  What's the best phone number to call you at? *

Please enter your address. *

Do you have an email address? *

What is your date of birth?

Don't worry, your personal data is secure with us.
Please enter your Social Security Number.

Your personal data is secure with us.
Okay, {{answer_22125619}}, Let's talk about your vehicle.

Year of vehicle:

Make of Vehicle :

(for example, "Ford" or "Volkswagen" or "Toyota")
Model of Vehicle

For example: "Jetta" or "Camaro"
VIN Number:

More about your vehicle.

Date you purchased the vehicle

Mileage of vehicle when you bought it

CURRENT mileage

Current Vehicle Owner's Name

Dealership where you bought the vehicle

Repairs and Defects.

Describe the defects and the repair attempts

How many times has your vehicle been repaired for the same defect?

# of days your vehicle has been in the shop

Do you have a loan on the vehicle? *

Financing Questions

Did you finance through the dealership?

Lien Holder Name

(for example, "Honda Motor Finance" or "Bank of America")
What is your monthly payment?

What was your down payment?

What was your trade-in amount(if any)?

What was the sales price of your vehicle?

Insurance Information

Insurance company

6 month or annual premium amount

Monthly premium on this vehicle

Total insurance premiums paid to date

Policy Number

Describe any accidents the vehicle has been involved with, including damage to the vehicle.

Provide the name of any Service Contract or Extended Warranty providers

You're done!  We got the information and we'll let you know what the next steps are on your case. Don't hesitate to contact us any time.