Certified Fleet Services / Sarasota - MV#80770
New Customer Questionnaire
Company Name:
*
First Name:
*
Last Name:
Phone:
*
Email:
*
Billing
Billing Address:
*
Select Address
Add an Address
Street Address:
*
Street Address 2:
City:
*
Country:
*
United States
Canada
Australia
China
Dominican Republic
Germany
Greece
Hong Kong
Mexico
Puerto Rico
Saint Lucia
State:
*
Postal Code:
*
Address Name:
*
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New Unit Questionnaire
What type of chassis is this unit:
*
Select Unit Type
Generator
Heavy Duty (default)
Light Duty
Medium Duty
RV
Trailer
Yacht
VIN
:
Year:
Make:
Model:
Unit Number:
Unit Nickname:
License Plate:
Service Request Questionnaire
Complaints / Problems / Requests
Describe first complaint, problem, or request:
*
How urgent is this:
*
Schedule as soon as possible
Schedule repair today
Emergency - Get this fixed right away
Remember for the next visit
Add another
Scheduling & Authorization
When will the unit be available for repairs:
Now
The unit MUST be accessed at the above date and time.
When would you like the unit back:
Return ASAP
How would you like us to access the unit:
*
Select Access Method
No preference, just get it done!
Customer will bring unit to the shop
Shop will service unit on-site
Shop will pick up unit and bring to the shop
Shop will tow unit
Where will this unit be located for access:
*
Select Address
Temporary Address (please put address in the Helpful Notes below)
Add A New Address
Street Address:
*
Street Address 2:
City:
*
Country:
*
United States
Canada
Australia
China
Dominican Republic
Germany
Greece
Hong Kong
Mexico
Puerto Rico
Saint Lucia
State:
*
Postal Code:
*
Address Name:
*
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Cancel
Would you like the shop to deliver the unit:
*
No - Customer will pick up unit from shop
Yes - Shop will return unit to customer
Where would you like this unit delivered:
*
Select Address
Temporary Address (please put address in the Helpful Notes below)
Add A New Address
Street Address:
*
Street Address 2:
City:
*
Country:
*
United States
Canada
Australia
China
Dominican Republic
Germany
Greece
Hong Kong
Mexico
Puerto Rico
Saint Lucia
State:
*
Postal Code:
*
Address Name:
*
Save
Cancel
Authorization Number:
PO Number:
Notes and Instructions For Shop:
Step 4: Additional Information:
Unit Identifier:
Driver Name / #:
Engine:
Reference #:
Payment Method:
Select Payment Method
ACH
American Express
Cash
Check
Credit
Discover
Gift Card
Internal Payment
MasterCard
National Account Credit
PayPal
Payroll Deduction
Third Party
Visa
How did you hear about us (e.g. shop website):
Submit