CUSTOMER PROVIDED - VEHICLE PROBLEM INFORMATION FOR BETTER DIAGNOSTICS - Please use this handy form to help you explain your car's problem. Then, return it to us when you bring your vehicle in for service. (** Keep it in the vehicle's glove compartment to be handy when you need it.)

YOUR NAME:_____________________ CAR: Yr:____ Make:__________ Model: _____________ License plate number:______________

PHONE NUMBER WHERE YOU CAN BE REACHED ON THE DAY WE'RE SERVICING YOUR CAR:

Home:____-___________ Bus: Ext:____-___________ Other:_____-__________ Cell Pager Friend

E-mail:_____________________ IF YOU HAVE VOICE MAIL, OR AN ANSWERING MACHINE, PLEASE PLAN TO CHECK YOUR MESSAGES FREQUENTLY

STARTING PROBLEM

Engine turns over but doesn't start. (Meaning that the engine SOUNDS like it wants to start)

This is the way it was in the beginning, but I think I ran the battery down in the process of trying to start the car.

You hear a "POPPING" or "SPUTTERING" sound.

Engine does not turn over at all. You can hear " A CLICKING SOUND.

Engine turns over, but S-L-O-W-L-Y.

Hard to start.. turns over a long time before starting.

The above happens when the engine is: COLD WARM BOTH

Other, please describe:

STEERING PROBLEM

Difficult to steer.

Difficult to steer when first started in the morning.

Makes noise when turning.. Describe noise

Steering wheel vibrates or wobbles when:

Car pulls to RIGHT or LEFT when:

Makes clattering noise when turning LEFT RIGHT

Other, please describe.

SUSPENSION PROBLEM

Clanking sound from front of car when going over bumps.

Car BOUNCES a lot on rough roads.

Car seems to "SWAY" when turning.

Other, please describe:

BRAKING PROBLEM

Low or spongy pedal.

Brake pedal seems extremely "HARD".

Makes noise when braking. Describe noise:

Brake pedal vibrates or pulsates.

Pulls to RIGHT or [ ] LEFT when braking.

Other, please describe:

HEATING & AIR CONDITIONING

No heat, but blows air. No heat & no blower.

A/C blows warm air. No fan & no A/C.

Air movement selector - vent - floor - defrost

Doesn’t work properly Blows out of wrong vent

OVERHEATING -COOLING SYSTEM PROBLEM

Engine running hot. Engine steaming or over heating.

White smoke from tail pipe. Inside of car is fogging up. []Foul odor, too.

fluid (antifreeze) leaking. The color is green orange red/ pink

TUNE UP - Driveability PROBLEM

Stalls or hesitates []Engine misfires or runs rough.

Engine check light On all the time On occasionally

Car seems to "BUCK" or 'JERK"

Other, please describe.

WHEN DOES IT HAPPEN?

When engine is: WARM COLD DAMP.

When car is Slowing down Idling Accelerating

At cruising speed Turning right Turning left

TRANSMISSION PROBLEM

MANUAL TRANSMISSION

Transmission slips Transmission/clutch slips

Shifts hard Chatters

Doesn't shift at all Won't go into gear

Noise

OIL LEAK

Low oil

No oil noticed on ground or in garage.

Oil leaking -judging from spots on the ground, the leak is coming from

Front of engine Center of engine Rear of engine Center of vehicle Rear of vehicle On the Right side Left side or more toward the middle The color of the oil is :

ACCESSORY PROBLEM:

Antenna Power Won’t go up or down Broken Manual Broken

Cruise Control not working

Door Locks

Horn No sound Some sound

Lights - Describe:

Mirror - Describe

Radio - Lights on, no sound

Seats Manual seat, won’t move Power - bench seat.

Split seat Driver side Passenger side

No forward or backward movement

No tilt No up or down

Windows Manual Power Driver’s side Front Rear

Passenger Front Rear

Wipers Washer Driver’s Passenger’s Rear

Wiper blade Wiper arm

NOISE PROBLEM:

Squeak Squeal Knocking Rattle

Happens while turning Left Right Both

Going over bumps When backing When applying brakes

Just at an idle - engine running, vehicle not moving

I can always hear it under above conditions

I can occasionally hear it

Noise coming from Front Rear Right Left

NORMAL MAINTENANCE

Needs lube, oil & filter.

Needs tune up (See: TUNE UP/Driveability)

Rotate Balance Replace-tires.

Check front end alignment. (See STEERING)

Transmission fluid and filter change

Check and/or Flush cooling system

Check brakes Clean and adjust brakes if O.K. for now.

Check belts & hoses Replace if necessary Check all lights/bulbs.