| Fill In Your Information |
| * Name: |
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| * Phone Number: |
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| * Email: |
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| How do you prefer to be contacted? |
Phone
Email
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When do you prefer to be contacted? |
Mornings (8am-12pm)
Afternoons (12pm-4pm)
Evenings (4pm-6pm)
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| Are you a new or returning customer? |
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| Address (if a new customer): |
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| City: |
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| State: |
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| Zip: |
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| How did you hear about us? |
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| If you were referred, who recommended us? |
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| Fill In Your Vehicle's Information |
| License Plate Number: |
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| * Vehicle Year: |
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| * Vehicle Make: |
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| * Vehicle Model: |
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| Color: |
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| Set Your Appointment Preferences |
| When would you like to schedule your appointment? |
| * 1st choice of date (mm/dd/yyyy) |
Calendar
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| Between: |
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| and: |
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| 2nd choice of date (mm/dd/yyyy) |
Calendar
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| Between: |
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| and: |
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| 3rd choice of date (mm/dd/yyyy) |
Calendar
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| Between: |
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| and: |
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| What will you prefer to do while the vehicle is being serviced? |
I will wait
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I will come back for it later
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I need to reserve an on-site loaner vehicle
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I will take the free shuttle service to my main address
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I need to take the free shuttle service somewhere else
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| If somewhere else, which address shall we be taking you to? |
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| Request Auto Services |
| Maintenance |
Not sure
3,000 Mile Maintenance Service
5,000 Mile Maintenance Service
10,000 Mile Maintenance Service
15,000 Mile Maintenance Service
20,000 Mile Maintenance Service
30,000 Mile Maintenance Service
40,000 Mile Maintenance Service
45,000 Mile Maintenance Service
60,000 Mile Maintenance Service
Premium Oil Change
Premium Synthetic Oil Change
Add BG Oil Additive
Complete Tire Rotation and Tire Balancing
Medix Vehicle Inspection
Replace Cabin Filter
Oil Passage Cleaning and De-sludge
Brake System Fluid Change (Brake Flush)
Fuel System and Intake Cleaning
Transmission Fluid Exchange (Transmission Flush)
Cooling System Fluid Exchange (Coolant Flush)
Replace Fuel Filter
Replace Spark Plugs
Replace Ignition Wires
Computer Diagnostic
Inspect timing belt
Water pump replacement
Heating and Air Conditioning (AC) repair or replacement
Brakes and Antilock Brake Systems (ABS) repair
Replace windshield wiper blades
Detailing and waxing car exterior
Washing and shampooing car interior
Other
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| Please provide as many details as possible on the services you selected above. |
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| Inspections |
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Not sure
Inspect Braking System
Inspect for Coolant Leak
Inspect for Fluid Leak
Inspect Exhaust System for Leak
Inspect Vehicle for Purchase
Inspect Vehicle for Trip
Other
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| Please provide as many details as possible on the services you selected above |
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| Additional Services, Comments and/or Questions |
| Please provide as many details as possible on any additional auto repair and maintenance services you need (detailing scratches and dents, etc). |
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