Name: 
Phone:     
Email address: 
 

Would you like us to keep you informed on the Preventive Maintenance suggested for you car by the factory ?

Yes No

Please select the most important benefits you want from your car:

Maintain performance & handling
Safety & performance
Not having to bring your car in for repairs (convenience)
Just getting to your destination
Feeling & looking good when you drive

Have you had you transmission serviced?   Yes No       
If yes, how long ago?

Have you had your cooling system serviced? Yes No        If yes, how long ago?
 

Does your vehicle ever experience a rough idle, hesitation or stall out?
Yes No        If yes, when does it occur? 

Have you had your fuel and air induction system serviced?

Yes No        If yes, how long ago? 

Do you have a problem with noisy power steering?

Yes No

Have you ever had you power steering serviced?

Yes No        If yes, how long ago? 

Have you noticed a foul odor in your air conditioning vents or excessive noise when the air conditioner is on?

Yes No        If yes, please describe? 

Do you have a problem with brake noise?

Yes No        If yes, please describe? 

Have you had your engine crankcase flushed? Yes No       
If yes, how long ago?