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.
start
 
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.