Drop Off Form

Name*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Phone*
Alternate Phone
Email*
Vehicle Year*
Make*
Model*
SERVICES*
- Oil & Filter Change
- Tire Rotation
- Transmission Service
- Brake Inspection
- Front End Alignment
- 30,000 Mile Maintenance
- 60,000 Mile Maintenance
- 90,000 Mile Maintenance
- Replace Wipers
SYMPTOMS*
- Select All
- Hard to start
- Will not start
- Starts but stalls
- Idle speed is unsteady
- Idle speed is too high
- Hesitates or stalls on acceleration
- Stalls on deceleration or quick stop
- Continues to run after turned off
- Backfires
- Speed changes for no reason
- Poor gas mileage
MPG*
THE SYMPTOMS OCCUR DURING*
- Select All
- Accelerating
- Decelerating
- Cruising
- Braking
- At a speed of MPH
MPH*
THE SYMPTOMS OCCUR WHEN ENGINE IS*
- Select All
- Cold
- Warming Up
- Normal
- Hot
- At all temperatures
THE SYMPTOMS OCCUR*
- Rarely
- Sometimes
- All the time
THE SYMPTOMS STARTED*
- Suddenly
- Gradually
At (mileage)*
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