Site Location?
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Please Select
Location #1
Location #2
Location #3
Team Member completing this form?
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First Name
Last Name
What number should we call back?
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Type of maintenance request?
*
General Site Issue
Wash Club Redemption Issue
Point of Sale Hardware Issue
Date of incident?
/
Month
/
Day
Year
Date Picker Icon
Time of the incident?
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Customer's Name
First Name
Last Name
Customer's Email Address?
Customer's Phone Number?
Customer's WashClub Number?
Vehicle Year
Vehicle Make
Vehicle Model
Vehicle Color
Describe the problem that has occurred with as much detail as possible.
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Attach Photo #1
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Upload 1st Picture
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Attach Photo #2
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Upload 2nd Picture
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Attach Photo #3
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Upload 3rd Picture
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Submit to Maintenance
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