What is your first and last name? Since your last visit at 12th Street Auto Care, has any of your contact information changed? Phone number changedHome address changedE-mail address changedNone What is your preferred method of contact? CallTextE-mail Would you like to receive oil change reminders? YesNo Would you like to receive a Complimentary Visual Inspection on your vehicle? YesNo How long do you plan on owning the vehicle being serviced? 1 year or less1 - 5 years5 or more years If you have locking lug nuts, where is the key located? I don't have locking lug nutsNot sureOther: Would you like to be informed if any other maintenance is due? YesNo If applicable, would you like us to save the old part(s) for you? YesNo Does the vehicle being serviced have an extended warranty plan? YesNoNot sure Are you interested in receiving information about an extended warranty plan for your vehicle? YesNo Would you be interested in auto repair financing? YesNo How did you hear about us? Do you have any other concerns with your vehicle besides the service already scheduled? Questions, Comments, Concerns, Feedback: Your Email (required)
