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Please complete this form if you have sold your vehicle since you became aware of the VW Emissions Scandal.

[contact-form][contact-field label=’Name’ type=’name’ required=’1’/][contact-field label=’Email’ type=’email’ required=’1’/][contact-field label=’Type of Vehicle’ type=’select’ required=’1′ options=’VW,Audi,Seat,Skoda’/][contact-field label=’Model Type eg VW Golf, Audi A6, Seat Ibiza, Skoda F abia’ type=’text’ required=’1’/][contact-field label=’Engine size’ type=’text’ required=’1’/][contact-field label=’Date of Purchase of Vehicle’ type=’text’ required=’1’/][contact-field label=’Date of Sale of Vehicle’ type=’text’ required=’1’/][contact-field label=’Did you buy the Vehicle New or Used’ type=’select’ required=’1′ options=’New,Used’/][contact-field label=’Value of Car When Bought?’ type=’text’ required=’1’/][contact-field label=’Value of Car When Sold’ type=’text’ required=’1’/][contact-field label=’Mileage of Car When Purchased’ type=’text’ required=’1’/][contact-field label=’Mileage of Car When Sold’ type=’text’ required=’1’/][contact-field label=’Condition of Car When Sold’ type=’select’ options=’Very Good,Good,Average,Below Average’/][contact-field label=’How Much Have You Lost Due To The Scandal’ type=’text’ required=’1’/][contact-field type=’text’/][contact-field label=’Please Support Your Estimate of Loss Below’ type=’textarea’ required=’1’/][/contact-form]

 

 

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