Tell Us About You
Full Name
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First Name
Last Name
Contact Number
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Please enter a valid phone number.
Email Address
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example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Can we text you at this number?
Yes
No
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Tell Us About Your Vehicle
Vehicle Year
Vehicle Make
Vehicle Model
What kind of service do you need?
*
Oil Change
Brakes/Transmission
Check Engine Light
Brake Fluid
Tire Rotation
Tire Repair/Replacement
Transmission Fluid
Previously Recommended Service
Pre-Purchase Inspection
AC/Heating Issues
Coolant
Other
If you chose "previously recommended service", please describe
If you chose "other", please describe
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Let's Schedule an Appointment Time
First preferred appointment date
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Month
-
Day
Year
Date
Second preferred appointment date
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Month
-
Day
Year
Date
First preferred appointment drop off time
After Hours Key Drop
7AM-9AM
9AM-12PM
Afternoon
Second preferred appointment drop off time
After Hours Key Drop
7AM-9AM
9AM-12PM
Afternoon
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Will You Need Transportation Assistance?
Drop off- I'd like a ride
Yes
No Thank You
If yes, first preferred drop-off time?
Hour Minutes
AM
PM
AM/PM Option
If yes, second preferred drop-off time?
Hour Minutes
AM
PM
AM/PM Option
I'd like to use S.T.A.R.S. for pick-up and delivery
Yes
No Thank You
If yes, first preferred drop-off time?
Hour Minutes
AM
PM
AM/PM Option
If yes, second preferred drop-off time?
Hour Minutes
AM
PM
AM/PM Option
Tow in by Ricks Towing (515.276.1848)
Yes
No Thank You
Please verify that you are human
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