Print, fill out and bring to First Choice Automotive.
| Customer Name: _______________________ Date: __________ Repair Order # __________ Rep: ____________ | |
| Starting Problems: | Cranks but won't start WIll not crank Starts, but takes a long time |
| Engine quits / Running Problems: | |
Quits: |
Right after starting While idling When parking During acceleration |
| When put in gear During steady speed driving Right after vehicle comes to a stop | |
| Poor idling conditions: | |
Idle Speed: |
Is too slow at all times Is too slow with A/C on Is rough or uneven |
| Is too fast Fluctuates up and down | |
| Poor running condition: | Runs rough Lacks Power Back-fires Bucks and jerks |
| Fuel, gas or sulfur smell Engine light on sometimes Engine light always on | |
| Misfires or cuts out Poor fuel economy Engine knocks, pings, rattles | |
| Dieseling or run-on Surges and / chuggles Hesitates or stumbles on acceleration | |
| Auto-transmission problems: Improper shifting (early / late) Changes gears randomly on it's own | |
| Vehicle does not move when in gear | |
| Poor handling: | Pulls to one side Hard steering Vehicle shakes and/or vibrates while moving |
| Noise problems: (explain) ________________________________________________________________________ | |
| Odor problems: (explain) _________________________________________________________________________ | |
| Problem frequency: | Always Often Occasionally |
| Usually occurs: | Morning Afternoon Evening |
| Engine temperature: | Cold Warm Hot |
| Vehicle speed: | Low Cruising High |
| Driving Conditions: | Short - less than 2 miles Less than 10 miles Long - more than 10 miles |
| During Occurrence: | Stop and go While turning While braking At gear engagement |
| With A/C operating With headlights on During acceleration During decceleration | |
| Rough road Mostly uphill Mostly downhill Mostly level Mostly curvy | |
| Driving habits: | Drive hard before engine is warmed Allow engine to warm |
| Mostly city driving Highway Park vehicle inside Park vehicle outside | |
| Outside weather: | Cold Warm Hot Wet/rainy Fog Snow/hail Dust/dirt Dry Humid |
| Additional notes and comments: | |
