Take Along Form
Hill's Garage Information Sheet
1. Name: ________________________________________________________________________________
2. Address: ________________________________________________________________________________
3. At what number can you be reached: ____________________________________
4. Vehicle: (Year, Make, Model) ________________________________________________________________________________
5. Vehicle Symptoms/Description: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________
6. When did you first notice a problem? ________________________________________________________________________________
7. Has the vehicle previously been worked on for this problem? ___ Yes ___ No If yes, what work was done?
________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________
8. Please explain when you notice the problem occurring:
________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________
9. Have you noticed any unusual sounds, odors, drips, leaks, smoke, warning lights or abnormal gauge readings?
________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________
10. Are you having any problems such as handling the car, braking, steering or unusual vibrations?
________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________
11. How often have you noticed the problem occurring?
________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________
12. Please provide any other additional comments that may be helpful:
________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________
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