Fields marked with a
*
are required
PERSONAL INFORMATION
Your Name:
*
Address:
*
City:
*
State:
*
Zip:
*
Telephone:
*
E-mail:
*
Preferred Date & Time of Appt.:
*
(M-Sat / 8- 5)
*
8:00 AM
9:00 AM
10:00 AM
11:00 AM
1:00 AM
2:00 PM
3:00 PM
4:00 PM
*
VEHICLE INFORMATION
Year:
*
Make:
*
Model:
*
Vehicle ID#:
License#:
*
Engine
(if applicable):
4 cylinder
6 cylinder
8 cylinder
10 cylinder
SERVICES YOU’D LIKE PERFORMED
Scheduled Maintenance:
Select if Applicable
3,000 Mile Service
6,000 Mile Service
24,000 Mile Service
48,000 Mile Service
100,000 Mile Service
Optional Maintenance:
Select if Applicable
A/C Service & Recharge
Automatic Transmission Service
Cooling System Flush & Refill
Changing System Inspection
Emissions Service
Flush & Change Differential Fluid
Flush Transmission & Refill
Front & Rear Suspension Alignment
Front Suspension Alignment
Fuel Filter Replacement
Headlight Adjustment
Replace Gas Shocks
Replace Front Brake Pads & Resurface Rotors
Replace Rear Brake Shoes & Resurface Drums
Other:
Rugby Homes & RV Center
1040 Highway 3 South | PO Box 351, Rugby, ND 58368 | 701-776-5878 |
info@rugbyhomesandrvcenter.com
|
Hosting by
NDTC