Site Location?
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McFarland
North Lake
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?
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General Site Issue
Wash Club Redemption Issue
ICS Hardware Issue
Date of incident?
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Day
Year
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Time of the incident?
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Customer's Name
First Name
Last Name
Customer's Email Address?
Customer's Phone Number?
Customer's License 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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