Wayne's Garage
342-3941 Eugene 746-7142 Springfield
Name: |
First:____________________ Last:________________________ |
| Address: | Street:________________________________________________ City:____________________State_____Zip: _________________ |
| Vehicle: | Year:__________Make:____________________ Model:_________________________License:________________ |
Services to be Performed: ____________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ |
|
| Please circle the number you can be reached TODAY. | |
Daytime Phone: |
____________________ |
Evening Phone: |
____________________ |
| Other: | ____________________ |
| ____________________@____________________.__________ | |
|
Were you given an estimate?____ |
|
Mininum Inspection/Diagnostic Charge: $36.00 |
|
| Please Sign: ________________________________________ | |