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COMPANY NAME
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FIRST NAME
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LAST NAME
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EMAIL ADDRESS
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PHONE NUMBER
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VIN
YEAR
MAKE
MODEL
UNIT NUMBER
LICENSE PLATE NUMBER
COMPLAINT, COMPLAINTS, PRODUCTS, OR REQUESTS
WHEN WILL THE UNIT BE AVAILABLE FOR REPAIR?
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Month
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Day
Year
Date
NEED UNIT RUSHED?
Return ASAP
HOW WOULD YOU LIKE US TO ACCESS THE UNIT?
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No preference, just get it done!
Customer will bring unit to the shop
Shop will service unit on-site
Shop will pick up unit and bring to the shop
ADDITIONAL NOTES FOR PICKUP
WOULD YOU LIKE THE SHOP TO DELIVER THE UNIT?
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Select a method of delivery....
No - Customer will pick up unit from shop
Yes - Shop will return unit to customer
ADDITIONAL NOTES FOR PICKUP
AUTHORIZATION NUMBER
PO NUMBER
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