Rochon Genova | Toronto Class Action Law Firm | Current Class Actions | Toyota

Toyota Questionnaire

Please provide the following information. Please note: This is for information gathering purposes only. This is not a claim form for compensation.

Rochon Genova will protect your name and all confidential information you submit against disclosure, publication or unauthorized user to the full extent under the law.

There is no charge or obligation for our review of your situation.

Once we have received your completed form, someone from our office will contact you with further information in the coming weeks.

Name:

Email:

Phone Number:

Address:

Toyota Model & Manufacturing Year:

Date of Purchase:

Purchase price of vehicle:

Have you experienced any acceleration problems?

If yes, please explain the nature of your acceleration problems:

Did you experience an accident/collision as a result of accelerator problems?

If Yes, please provide details including date of accident/collision and details of any injuries sustained:

Were any repairs made as a result of acceleration problems?

If yes, please provide details including cost of repairs:

Did you contact Toyota or your Toyota dealership regarding accelerator problems?

If Yes, please provide details of what Toyota advised:

Other Comments: