Customer Intake Form

Standardized intake capturing vehicle info, concerns, and history

Customer Information

Full Name

Phone Number

Email Address

Address

Preferred Contact

New or Returning?

Year

Make

Model

VIN

License Plate

Mileage

Color

Engine Size

Customer Description of Problem

☐ Check Engine Light ☐ ABS Light ☐ Airbag Light ☐ Oil Light ☐ Battery Light ☐ Temperature Warning

☐ Noise ☐ Vibration ☐ Fluid Leak ☐ Performance Issue ☐ Electrical Problem

Last Service Date

Last Service Performed

Authorization Limit ($)

Additional Notes / Special Instructions

Customer Signature: _______________________________ Date: ____________

Service Advisor: _______________________________ Time In: ____________