434 Prospect St.
Pawtucket, RI 02860
Bus. 401-726-6699
Fax. 401-726-8059
24hr. 401-728-4250
 

Request for Service Form

Vehicle Information

*Year:
*Make:
*Model:
License Plate #:
Mileage:

Service Information

Regular Scheduled Maintenance Adjust Brakes
Oil Change Replace Muffler
Coolant Flush State Inspection
Transmission Flush Air Conditioner Repair
Engine Tune-up Balance Tires
Tire Rotation Other Service
Front End Alignment

Additional Information or Comments:

*Preferred Appointment Date:
*Preferred Appointment Time:

PLEASE NOTE: Your appointment is not confirmed until you are notified by your Preferred Contact.

Contact Information

*First Name:
*Last Name:
*Home Phone:
Cell Phone:
*Email Address:
Address 1:
Address 2:
City:
State:
Zip Code:
*Preferred Contact:

 

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