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Personal Information
First Name:     Last Name:

Phone #s:    Home      Work    Cell    Other 

Street Address: City: State: Zip:

Vehicle Information Year: Make: Model: Engine Size:Litres

My vehicle has:  Turbo? Transmission? Drive type?
Appointment Options Appointment date requested:
1st Choice:  Month   Day        2nd Choice:  Month   Day 

I would like to:
Wait there while my vehicle is being serviced     Approximate Arrival time time: 
Drop my vehicle off for service                             Approximate drop-off time: 

     I would like to request a:
      Ride  •••••••••••••••>  Ride to location: 
      Rental Car  ••••••••>  Car Type:   (Must be over 25 years of age)
      Loaner Car (Must be over 25 years of age, sign liability release, and present driver's license and current proof of insurance)
Vehicle Maintenance and/or Repairs Requested
Free Courtesy Check Check Brakes Replace Timing Belt   Fluid Service: 
Lube, oil & filter Tire Rotation  Mileage Service: 
To select more than one item,
Click while pressing 'Ctrl' key
Additional Services Requested
1) 
2) 
3) 
4) 
5) 
6) 
7) 
8) 
Additional Comments:

     What method(s) should we use to respond to you?
      EMail  •••••••••••••••>  EMail Address: 
      Phone  •••••••••••••••>  Daytime Phone #1:  Daytime Phone #2: 
      FAX  ••••••••••••••••>  Fax #: 

We will try to respond to your request as quick as possible. If you have not received a response
within 24 "business" hours from now, please call us to verify that we received your request.
               

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