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Firestone Questionnaire

Please completely fill out each form.

What type of vehicle were the tires on?
Make: Model Year:
What model tire did you use?
What was the size?
How were the tires obtained?
They came with the car.
     Where and when did you purchase the vehicle?
     Was the car purchased curently new or used?     New Used
I purchased on my own.
     Where and when did you purchase?
At issue, did you replace the Firestone tires ? Yes No
If so, what was the total cost of replacing the tires?
Did you suffer hysical or propery damage as a result of the tires? Yes No
If so, please provide details:

First name: Last name:
Your email address: (e.g.: you@aol.com)
Address
City State Zip
Country
Phone Fax

Would you prefer us to send you legal information by:
U.S. Mail    E-Mail    Fax    Phone

If you prefer to give this information to an attorney directly,
please call: 1-800-365-1121

 

   
 

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