Check-In Form
New Or Existing Customer
*
New
Existing
Name
*
First Name
Last Name
Company Name (if applicable)
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Vehicle Information
License Plate #
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Year | Make | Model
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Color of Vehicle
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Black
White
Silver
Blue
Red
Gold
Grey
Other
Exact Mileage
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(Yes, we need the exact mileage for warranty & liability reasons)
Do you have an extended warranty?
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Yes
No
If Yes, What Provider?
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Appointment Information
Are you checking in for a regular maintenance service or needing a diagnosis performed?
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Routine Service
Both
Diagnosis
Other
Please Choose Condition Of Vehicle
Cranks & Starts
Cranks & No Start
No Crank & No Start
Choose What Services You Would Like Performed Below
*
Please List Additional Services That Are Not Listed Above
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Please Fill Out This Section If We Are Diagnosis A Problem
The more information that we receive, the better chance of our technicians diagnosis successfully!
Do You Have Lights Illuminated On Your Dash?
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Yes
No
What Light Is Illuminated That We Are Diagnosing?
Any Additional Lights You Would Like Diagnosed?
Multiple lights may be related issues. All diagnosis are written up for 1 hour @ $170. Our technicians are very honest and fair, so potentially it might be less than a full hour, depending on what is found. *Diesel Vehicles Not Included*
Do You Hear A Noise Coming From The Vehicle?
Yes
No
Please Choose What Sound Is Heard
A/C Diagnosis
Please Choose the Best Option
A/C Does Not Blow At All
A/C Blows Warm
A/C Is Intermittent
Noise Coming From A/C
Other
Please describe in more detail if applicable.
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Terms & Conditions
I hereby authorize the work to be done along with the necessary materials. You and your employees may operate vehicles for purposes of testing, inspection, or delivery at my risk. An express mechanic’s lien is acknowledged on vehicles to secure the amount of repairs therto. In the event legal action is necessary to enforce this contract, I will pay reasonable attorney’s fees and court costs. I acknowledge this deposited property is not insured or protected to the amount of actual cash value thereof by the dealer against loss occasioned by theft, fire, and vandalism while such property remains with the depositary. I also acknowledge no articles of personal property remain with the depository. I also acknowledge no articles of personal property have been left in the vehicle and the dealer is not responsible for the inspection. Signing puts signee in agreement with Professional Automotive Service policies.
Signature
*
Date
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/
Month
/
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
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