Pharis Law Offices
Please use the following form to submit information to us via email so that we can evaluate your claim. This is at no charge to
you! All information gathered is kept confidential.*Before you submit the information, please read the note below.*
Personal Info
Name:
Your street address:
City, state, zip:
Your email address:
Your work number:
Your home phone:
Your cell phone:
Your fax:
Vehicle Details
Make:
Model
Purchase/Lease Date
Purchase or Lease?
Purchase
Lease
This vehicle was
purchased:
New
Used
Demo
Current mileage:
Relief sought
Repurchase
Cash back
Selling Dealer:
Dealer address:
City, state, zip:
I
n the spaces provided, please list the the approximate date(s) when the vehicle was inspected and/or
repaired, COMPLAINT that you made, the repairs made and if the repair facility was the same or a
different dealer
.
Date of Repair
Mileage
Complaints Made:
Repairs Made:
Which dealer?
Please feel free to add any additional comments in the space below:
*Note: Submitting the form will send an email to Pharis Law Offices email about your claim.
However, neither your submission to our website nor any response to it creates an
attorney-client relationship, which must be in writing and show a clear intent by an attorney and
client to employ the attorney for a specific legal matter. Your email submission of your claim
form does not create an attorney-client relationship and no responsibility by the attorney for
your case should be assumed. It is advised that before you take specific action that will affect a
claim you may have, you should have a written agreement with an attorney.
Go to Pharis Law Offices Home Page