Customer Comments & Requests

Auto Repair Feedback Form

We would appreciate it if you would take a few moments to answer the following questions. Please be assured that we do not share or sell personal information about you except when we have your permission.

First Name

Last Name

Address Line 1

City

State

Zip Code

E-mail Address

Phone

How did you hear about our auto repair shop?

Who helped you today?

How high is your level of satisfaction with the services you received?

Very High

High

Neutral

Low

Very Low

What is your overall impression of our auto repair shop?

Very High

High

Neutral

Low

Very Low

Do you have any suggestions on how we might improve?

Bold = Required field

Would you recommend us to others?

Yes

No

Maybe

Automobile Maintenance Scheduling Form

To receive a quote for your prospective job, please answer the following questions. We will reply to you as soon as possible with an estimate of the cost of the job, based on the information you provide. All information will be kept confidential.

First Name

M.I.

Last Name

Address

City

State

Zip Code

Country

E-mail Address

Phone

Alternate Phone

Fax

How did you hear about our business?

How would you like us to respond to your request?

E-mail

Postal Mail

Phone

Fax

Personal Visit

Bold = Required field

Type of Customer:

Residential

Commercial

Company Name

Applicant's Position in Company

Make

Model

Year

Transmission

Manual

Automatic

Preferred Time & Date of Appointment

Preferred Time & Date – 2nd Choice

License Plate #

Odometer

Vehicle Identification # (VIN)

Reason for Visit

Area of Concern *

Other Area of Concern

Describe any other aspect of the vehicle's condition or the service you would like performed.