Service Request Form * - required entry

Cedar Rapids 2740 6th St SW Cedar Rapids, IA 52404 (319) 364-2491 (800) 728-6699 Service: Mon - Fri: 24 Hours Sat: 7:00am - 4:30pm Sun: Closed	Davenport 3665 W 83rd St Davenport, IA 52806 (563) 326-4002 (877) 319-3687 Service: Mon - Fri: 7:00am - Midnight Sat: 7:00am - 3:30pm Sun: Closed	Decorah 1656 State Highway 9 Decorah, IA 52101 (563) 382-8761 (800) 798-8761 Service: Mon - Fri: 7:00am - 9:00pm Sat: 7:00am - Noon Sun: Closed	Dubuque 1190 Roosevelt St Dubuque, IA 52001 (563) 557-8170 (800) 747-8170 Service: Mon - Fri: 7:00am - Midnight Sat: 8:00am - 4:30pm Sun: Closed	Sterling 23906 Moline Rd Sterling, IL 61081 (815) 625-7798 (866) 474-7331 Service: Mon - Fri: 7:00am - 8:30pm Sat: 7:00am - 3:30pm Sun: Closed	Waterloo 2420 K Line Dr Waterloo, IA 50701 (319) 233-8313 (800) 373-8313 Service: Mon - Fri: 7:00am - Midnight Sat: 7:00 am - Noon Sun: Closed

Customer Information First Name:* Primary Phone:* Last Name:* Secondary Phone: Company Name: Email Address:* Address 1st line:* Preferred method of contact: Phone     Email Address 2nd line: City or Town:* State:* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming Zip:*   Vehicle Information VIN #   UNIT #   Miles*   Make*   Model*   Year (yyyy)*   Preferred service location: Cedar Rapids   Davenport  Waterloo  Dubuque  Decorah  Sterling Preferred service date: (mm/dd/yy)   Preferred service Time: None 1:00 2:00 3:00 4:00 5:00 6:00 7:00 8:00 9:00 10:00 11:00 12:00 AM     PM         Select the appropriate boxes for the service requested PM Services Oil Change Transmission service Drive axle service Winterization Fuel tank cleaning DPF cleaning PM Services Comments:   Engine Does not start Does not turn over Difficulty turning over Hesitates Noticeably poor fuel mileage Stalls when starting Stalls when decelerating Idle speed is too high Knocks or pings Smokes Unsteady idle Engine Comments:   Noise & Vibration Noise Vibration Both apply When in reverse During normal acceleration During normal deceleration When braking When accelerating When decelerating When turning When engine is running and vehicle is moving When engine is running and vehicle is not moving Noise Comments:   Transmission Difficult to shift, does not shift properly Shifts prematurely or slowly Does not upshift Does not downshift Slippage Shifts harshly Will not shift at all Makes unusual noises when shifting Transmission Comments:   Brakes Front brakes Rear brakes Both front and rear Unable to determine Brake pedal must be pumped continuously for vehicle to stop Brake pedal must be depressed fully for vehicle to stop at any speed: Vehicle pulls to one side when braking Brakes squeaking Brakes squealing Brakes grinding Brakes rattling Brakes Comments:   Electrical Lights Front Reverse Tail lights Left turn signal Right turn signal Hazard Trailer Interior dome Lighter Dashboard display Power windows Front driver-side Front passenger-side Rear left Rear right Sound system AM/FM stereo cassette AM/FM stereo Compact disc player Front speakers Rear speakers   Windshield wipers Windshield wiper spray Driver's seat adjustment Rear defroster Power locks Rearview mirrors Security system Electrical Comments:   Front end alignment/Steering & handling Vehicle shakes when in operation Vehicle vibrates when in operation Vehicle ride is rough and uneven Excessive steering is required for vehicle to stay on course Steering wheel feels 'tight' when making turns Steering wheel feels 'loose' when making turns Front end alignment/Steering & handling Comments:   Body & Paint Repair required: Body work Repair required: Paint work Repair required: Panel alignment Repair required: Air leaks Water leaks:(Describe where the water leaks) Body & Paint Comments:   Heating & cooling Air conditioner does not have any cooling effect Air conditioner not cold enough Air conditioner takes an abnormal amount of time to cool interior Heating does not have any heating effect Heating does not have proper heating effect Heater takes an abnormal amount of time to function Air flow does not function properly Air flow does not function: Center Air flow does not function: Driver-side Air flow does not function: Passenger-side Air flow does not function: Floor Air flow does not function: Defroster Temperature fluctuates greatly Difficulties with air intake: Recirculating air Difficulties with air intake: Outside air System makes unusual noises or vibrations Heating & Cooling Comments:   Other: