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Vehicle Information

Manufacturer*

Year*

Model*

Miles

Was Your Vehicle purchased or previously serviced at Ralph Thayer Automotive?
Make Selection Yes No

Transportation Arrangements
Make Selection Waiting Dropping Off Requiring Shuttle Service Rental Vehicle

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Service Information

Type of Service Needed*
Make Selection Periodic Maintenance Inspection (PMI) Change Oil & Filter Rotate Tires Rotate & Balance 4 Tires Front End Alignment Four Wheel Alignment Transmission Service Cooling System Service Adjust Brakes Adjust Clutch Replace Wiper Blades State Inspection Emission Test Install Order Part Tune-Up Check Oil Leaks Check Coolant Leaks Check Transmission Leaks Check Engine Light On Dash Board Light On ABS Light On Ride Control Light On Reline Brakes Check Exhaust System

Special Requests:

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Preferred Appointment Time and Date*
Appointment requests must be at least 5 working days in advance!

Date

Time
8:00 9:00 10:00 11:00 12:00 1:00 2:00 3:00 4:00

Alternate Appointment*
Date

Time
8:00 9:00 10:00 11:00 12:00 1:00 2:00 3:00 4:00

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Contact Information

Full Name*

Email*

Home Phone*

Day Phone*

Fax

Address*

City*

State*

ZIP*

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Preferred Contact Method Make Selection Phone Morning Phone Midday Phone Evening Email Fax

* - Required Fields