NATIONAL
South
Pug~!M~N~v1lo~E~
AUTOMOTIVE
TECHNICIANS
EOUCAT
I
ON
FOUNOATION,
INC.
AUTOMOTIVE SERVICE
AND/OR
REPAIR REQUEST
NAME:
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STREET:
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_
CITY:
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ZIP:
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PHONE:
YEAR:
. MAKE:
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MODEL:
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ENGINE: (circle
on
e ) 4
CYL
6
CYL
&CYL DIESEL ·
OTHER
TRANSMISSIO
N:
(circle
on
e)
MANUAL
AUTO
iv1A
TIC
PROBLEM
EXPERIENCED: _ _
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SYMPTOMS OBSERVED
:.
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(PLEASE
DO
NOT
WRITE BELOW THIS LINE)
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·
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VEHICLE PRE-INSPECTION
EX1ERIOR PAINT
..
......
CHIPS,
SCRATCHES
, ETC
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_ _ _
GLASS .... .' ..........
CRACKED
,
CHIPPED,
MISSING
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_
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VISIBLE BODY DAMAGE
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:MISSING
HUB
CAPS ..... BEAUTY
RINGS
, CENTER CAPS
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UNDER
CARRIAGE.
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INTERIOR SEATS ...........
RIPS,
STAINS
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NIISSING INTERIOR/EXTERIOR
PARTS
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VALUABLES, JEWELRY,
ETC,,
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