| Customer Information |
| Name | |
| Address | |
| City | |
| State | |
| Zip Code | |
| Home Phone | |
| Daytime Phone | |
| Fax Number | |
| Email address | |
| Please Contact Via |
Phone-day
Phone-eve
Fax
Email
|
| Please enter a convenient date and time for your appointment: |
| Choice: |
|
| Vehicle Information |
| Vehicle Serial Number | |
| Vehicle Model | |
| Vehicle Year | |
| Vehicle Mileage | |
| License Plate | |
| Service Needed |
Quick Service Menu
Check all services needed
|
Oil and Filter Change
Oil and Safety Service
Replace Heater/AC Micro Filter
Inspection I
Inspection II
Brake Fluid Change
Coolant Flush
Front Brakes
Rear Brakes
Front & Rear Brakes
Four Wheel Alignment
Balance 4 Tires
Clean & Detail
Replace Wiper Refills
Fuel System Cleaning
|
| Repair Line #1 | |
| Repair Line #2 | |
| Repair Line #3 | |
| Repair Line #4 | |
| Problem/Symptom Checklist |
|
Please take a moment to complete the Problem/System Checklist in the event one or more of your concerns
involve repairing any drivability, noise or leak problems. We welcome the opportunity to have the shop foreman
test drive your BMW with you so you may point out any concerns. It is our sincerest desire to repair your
concerns right the first time, on time, every time. Your assistance may be vital to our success.
|
| History |
Has the problem been previously diagnosed or worked on?
Yes No
|
If yes, by Circle BMW or some other dealer?
Circle BMW Someone else
|
When was this work done?
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What was done to correct the problem (if done by an outside shop)?
|
Can complaint be duplicated on a test drive?
Always Sometimes |
| Frequency |
How often does it occur?
|
After what length of time (minutes, hours)? Number of miles?
|
| Geographic Location |
Does the problem occur in a specific location or on a certain road
Yes No |
If yes, please specify?
|
| Road Conditions (choose one or more) |
|
|
| Weather Conditions |
Outside temperature?
|
Sunny, Rain, Fog, Snow, Ice, Overcast, Windy?
|
| Vehicle |
Road Speed?
|
Number of passengers (including driver)?
|
Location of passengers RF LF LR MR RR?
|
Load in trunk (weight and type of objects)?
|
| Engine |
RPM?
|
Coolant temperature (cold, normal, hot)?
|
Engine load (idle, light accel, med accel, WOT, cruise, decel)?
|
Gauge readings?
|
Warning lights?
|
| Leaks |
| Have you noticed any leaks? Yes No |
| If yes? |
Location of leak?
|
Color of leaked fluid?
|
Amount (how much was added)?
|
| Noises |
| Have you noticed any noises? Yes No |
| If yes? |
|
|
| Thank You, Please Select |
| |
