Please complete this form to ensure your vehicle service is booked accurately.
First Name
Last Name
Phone Number
Email Address
Street Address
City/Town
State/Province
Postal/Zip Code
Make
Model
Year of Manufacture
Vehicle Identification Number (VIN)
License Plate Number
Current Mileage/Kilometrage
Fuel Type
Please select the type of service required and provide a detailed description of any issues.
Standard/Manufacturer Scheduled Service
Oil Change / Lube Service
Inspection / Diagnostic
Tire Services: (e.g., Rotation, Replacement, Alignment)
Brake Services: (e.g., Pad replacement, Rotor machining)
Other:
Please describe any specific issues you are experiencing (e.g., strange noises, warning lights, performance problems):
Please list any specific parts you want replaced or additional services requested:
Preferred Date 1
Preferred Time 1
Preferred Date 2
Preferred Time 2
Service Completion Time (e.g., Same-day, 24 hours, etc.)
I will drop off the vehicle at the service center.
I require a pick-up service.
I require a loan/courtesy vehicle.
I require a shuttle/ride service.
I do not require alternative transportation.
Maximum Expenditure Limit (Optional): I authorize service up to a maximum amount of:
I require a quote and authorization before any work is performed.
I authorize the technician to perform diagnostic testing.
I confirm that all information provided is accurate.
I understand that the preferred date/time is subject to availability and will be confirmed by the service center.
I understand that the service center will contact me if additional work is required beyond what is authorized.
Customer Signature