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City:
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State:
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Zip:
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Phone (Today):
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Phone 2:
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Cell Phone:
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Email address:
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Company:
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Commercial Customers - Please Enter Company Name.
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| How did you hear about Siler City Automotive? |
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Do you prefer an
estimate before services are performed?
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Yes
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No
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| Is Roundtrip shuttle
a benefit you would use? |
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Yes
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No
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| I normally service my
vehicle: |
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Every 3 months
or 3,000 miles
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(our recommended interval) Every 5 mo or 5000 miles
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Seldom,
only when my car is in for other repairs
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Never, I’ll
wait for a breakdown
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I like to keep my car... |
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in like new condition
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Dependable
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Fix
it when it breaks
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Behind a tow truck
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Has your car ever been in an accident? |
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Yes
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No
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Are you the original owner? |
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Yes
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No
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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.) |
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Do you keep service records? (You can access yours online with us) |
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Yes
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No
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When was the last time someone worked on your car and what did they do? |
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| Do you prefer to get
all of your services completed at one location, including extended
warranties? |
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Yes
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No
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| Do you prefer to be
updated throughout the day when your car is in for service? |
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Yes
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No
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| When selecting an automotive
service facility, I look for: |
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Someone I
can trust
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The cheapest
prices
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Locationy
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Brand names
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Warranty
coverage
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| Do you expect us to
notify you of any services we might see are due on your car while
it is in for service? |
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Yes
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No
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(If we see something, it’s
our responsibility to tell you.) |
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In the state of NC it is a misdemeanor offense to operate an unsafe vehicle |
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| What type of Warranty
do you prefer? |
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90 days/4,000
miles
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12 months/12,000
miles
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24 months/24,000
miles
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(This is our warranty) |
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| Do you have extended
warranty on any of your vehicles? |
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Yes
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No
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| I prefer to pay for
automotive service by: |
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Check
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Credit Card
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Cash
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90 days Same
as Cash Plan
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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. Siler City Automotive's 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 Siler City Automotive 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.
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I accept the above
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NO REPAIRS DONE WITHOUT YOUR AUTHORIZATION
Thank you for your time and the opportunity to service all of
your automobile repair needs.
At Siler City Automotive, “The
Service Will Amaze You!”
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Customer Signature
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