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New Customer Form

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Spouse
Home Phone
Cell Phone*
Work Phone
Birth Month
Birth Day
Spouses Birth Month
Spouses Birth Day
How would you like to be contacted?*
How did you hear about us?*
Reason for visit*
Would you like a free 30 point courtesy check?
- Yes
- No
We have a credit program that offers interest-free financing. Would that interest you?
- Yes
- No
I authorize you and/or your employees' permission to operate the car or truck herein described on street, highways or elsewhere for the purpose to testing and/or inspection. An express mechanic's lien is hereby acknowledged on car or truck herein to secure amount of repairs.
Date*
MM slash DD slash YYYY
Make*
Model*
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