Les Mack Service Request Form

Name

Address

City

State

ZIP

Day Phone

Evening Phone

Email address

Make

Year

Model

Mileage

Date and Time Requested
(please allow 3 business days to ensure appointment)

Use This Handy Checklist
Miles Service
Inspect Brakes
Alignment
Balance Wheels
Rotate Tires
Adjust Valves
Engine Tune Up

Change Oil & Filter
Change Transmission Oil
Check AC/Heating Systems
Check Exhaust System
Check Steering & Shocks
Adjust Clutch
Flush Radiator & Add Anti Freeze

Other service desired or service details. Please describe problems and be specific. Thank You.

Security test. Please identify the pictures: