Customer Information sheet

It is our Goal to make this the most comfortable and rewarding experience you’ll ever have at an automobile repair facility. In order to tailor our service to your specific needs, please take a few moments to complete the following questionnaire.

Date:
   March 10, 2010    
Mr.
Mrs.
Ms.
Miss
Name:
Spouse:
Address:
Apt #:
City:
State:
 Zip:
Phone (Today):
Phone 2:
Cell Phone:
 Email address:
Company:



Commercial Customers - Please Enter Company Name.
How did you hear about PAS (Parkway Automotive Services)?  
Val Pak
Mail
Friend        
TV          
Another Shop          
Radio          
Better Business Bureau          
Chamber of Commerce          
Rx bag at Kroger          
ENO          
AAA  
Team National                    
Newcomers visit                    
Sign                    
Internet                    
Brochure                    
Phone Book
Other Explain
       
Do you prefer an estimate before services are performed?
Yes
No
       
Is Roundtrip shuttle a benefit you would use?
Yes
No
   
       
I normally service my vehicle:
Every 3 months or 3,000 miles
(our recommended interval) Every 5 mo or 5000 miles
Seldom, only when my car is in for other repairs
Never, I’ll wait for a breakdown
       
Would you like more information on how to get free oil changes, and discounts on labor for the rest of your life? (We offer a Lifetime Preventative Maintenance Plan)
Yes
No
       
I like to keep my car...
in like new condition
 
Dependable
 
Fix it when it breaks
Behind a tow truck
       
Has your car ever been in an accident?
Yes
No
   
       
Are you the original owner?
Yes
No
   
       
Is there anything about the car that does nor work or anything about the car we should know? (i.e. don't roll down driver's window etc.)
       
Do you keep service records? (You can access yours online with us)
Yes
No
   
       
When was the last time someone worked on your car and what did they do?
       
Do you prefer to get all of your services completed at one location, including extended warranties?
Yes
No
   
       
Do you prefer to be updated throughout the day when your car is in for service?
Yes
No
   
       
When selecting an automotive service facility, I look for:
Someone I can trust
  
The cheapest prices
  
Locationy
  
Brand names
  
Warranty coverage
  
       
Do you expect us to notify you of any services we might see are due on your car while it is in for service?
Yes
No
  (If we see something, it’s our responsibility to tell you.)
  In the state of Arkansas it is a misdemeanor offense to operate an unsafe vehicle
       
What type of Warranty do you prefer?
90 days/4,000 miles
  
12 months/12,000 miles
  
24 months/24,000 miles
 (This is our warranty)
       
Do you have extended warranty on any of your vehicles?
Yes
No
   
       
I prefer to pay for automotive service by:
Check
Credit Card
Cash
90 days Same as Cash Plan
   
       

YOU HAVE AUTHORIZED US TO SERVICE YOUR AUTOMOBILE.

This warranty covers material and labor for a period of 24 mo/24,000 miles, whichever comes first, unless otherwise stated on the repair order. This warranty starts from the date the work is completed and includes any defects in workmanship arising from repairs performed under the original invoice. It does not cover incidental or consequential losses such as towing, loss of earnings, per diem expenses, rental car expenses, or any other claims whatsoever. Parkway Automotive Services’ obligation under this warranty is limited to replacing or repairing damaged and/or defective parts and labor incurred in the performance of that task. If Parkway Automotive Services has not shown on your repair order that it specifically replaced or repaired an item, it is not covered under the warranty. Any damage caused by neglect, abuse, misuse, or collision is not covered by this warranty. This warranty is non-transferable and limited to the customer listed on the repair order.

Shop supplies are those miscellaneous items that are used in our shop which are too numerous to list. A sample list is posted in our office. Also included are hazardous waste fees that we now have to pay. Any vehicle left seven (7) days after completion will be subject to storage charges and will be subject to sale after thirty (30) days. You have authorized us to drive your vehicle for test purposes. We cannot be responsible for personal items left in your vehicle. All repairs must be paid in full before your vehicle is delivered.

       
   


I accept the above

NO REPAIRS DONE WITHOUT YOUR AUTHORIZATION
Thank you for your time and the opportunity to service all of your automobile repair needs.

At Parkway Automotive Services, “The Service Will Amaze You!”
       
 
Customer Signature