Confirmation of Client Information for Filing of CA Complaint *If More Than 1 Car, Please "Refresh" and Submit Multiple Forms: Email: Home Address - Street (Ex. 1234 Cherry Lane, Apartment 4B): Home Address - City (Ex. Beverly Hills): Home Address - County (Ex. Los Angeles): Home Address - ZIP (Ex. 90210): Nissan Model (Ex. Sentra, Versa, Rogue, Altima, Pathfinder, Murino, Maxima, etc.): Year of Car: TOTAL CVT Trans. Repair Attempts (Add together: Actual Repairs (regardless if the repairs were made under the original warranty or not) + # of times you took the car in with complaints but were turned away): Purchased or Leased: New or Used: Still own Car? Approximate Mileage (OPTIONAL): Names of ALL Persons On Vehicle Registration: State Car Purchased/Leased: Selling Dealer Name: Names of ALL Servicing Dealers OTHER Than Selling Dealer (if NONE, type "NONE"): Notes to us (OPTIONAL): SUBMIT