Hometown

Transmissions

Customer

                  

  Date:  ____________

 

 

Name:  ____________________________________________________

 

Telephone Number:    ________________________________________

Vehicle

 

   Year:  _______      Make and Model:  ________________________________

 

   Milage:  __________      Vin #:  _________________    Plate #:  __________

 

          Automatic                          2wd                                  Yes Overdrive

 

          Manual                              4wd                                  No Overdrive

 

   Transmission Type: _______________         Engine Size:  ________________

Problem/Questions

 

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________