| Customer Name __________________________________________ Date _____________________ |
| Address ___________________________________________________________________________ |
| City / State / Zip ____________________________________________________________________ |
| Phone # (Home) _________________________ (Work)_______________ (Cell)________________ |
| Year ___________ Make ____________ Model __________________ Color ___________________ |
| Description of problem or service requested: ____________________________________________ |
| __________________________________________________________________________________ |
| Alarm system? Y / N Instructions to start: ______________________________________________ |
| Signature to authorize road test / diagnostics ____________________________________________ |
* Road test is free. Labor rate is $70.00/hour. *
* Computer scan is $85.00 (includes $50.00 equipment fee and 30 min. labor) *
|
| ========================================================================= |
| (Office use only) |
| Tow required? Y / N Address__________________________________________________________ |
| Reg # _______________VIN ____________________________________ Mileage ______________ |
| Engine size ____________ Transmission type ______________ Fluid level & cond. ______________ |
| R&D by _______________ Codes & Diagnosis ___________________________________________ |
| __________________________________________________________________________________ |
| Cost to repair ____________________________ Completion date ____________________________ |
| Signature to authorize repair __________________________________________________________ |
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