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First Name: *

Last Name: *

Country: * SelectUnited StatesCanada

Street Address: *

City: *

State/Province: * StateALABAMAALASKAARIZONAARKANSASCALIFORNIACOLORADOCONNECTICUTDELAWAREDISTRICT OF COLUMBIAFLORIDAGEORGIAHAWAIIIDAHOILLINOISINDIANAIOWAKANSASKENTUCKYLOUISIANAMAINEMARYLANDMASSACHUSETTSMICHIGANMINNESOTAMISSISSIPPIMISSOURIMONTANANEBRASKANEVADANEW HAMPSHIRENEW JERSEYNEW MEXICONEW YORKNORTH CAROLINANORTH DAKOTAOHIOOKLAHOMAOREGONPENNSYLVANIAPUERTO RICORHODE ISLANDSOUTH CAROLINASOUTH DAKOTATENNESSEETEXASUTAHVERMONTVIRGIN ISLANDSVIRGINIAWASHINGTONWEST VIRGINIAWISCONSINWYOMINGALBERTABRITISH COLUMBIAMANITOBANEW BRUNSWICKNEWFOUNDLAND AND LABRADORNOVA SCOTIAONTARIOPRINCE EDWARD ISLANDQUEBECSASKATCHEWAN

Postal Code: *

Email: *

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Vehicle Identification Number (VIN): *

The VIN has 17 characters which are a combination of letters and numbers. It can be seen from outside the vehicle by looking through the windshield at the edge of the dash closest to the roof pillar on the driver side of the vehicle. It will also be on the vehicle registration and insurance cards as well as on most Repair Orders.

Transmission Type:
Manual
Automatic
Continuously Variable (CVT)

Has the vehicle been involved in one or more of the following? Check all that apply.:
Fire
Crash
Death
Injury

Has the vehicle been involved in one or more of the following? Check all that apply.:
accelerator/throttle
accessories (cd/tape, radio, navigation system, etc)
air conditioning/heat
airbag
body & frame
brakes
computer controls
doors & windows (non-power)
driveline (differential, transfer case, u-joints)
electrical/battery
engine
engine cooling (radiator, water pump)
exhaust/emission
fuel economy
fuel system
lights (exterior & interior)
mirrors
OTHER (identify in Problem Description Box)
paint
power options (window/door/seat/roof)

Problem Description: