Information
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Tag Number
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YEAR - MAKE - MODEL
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Name
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Phone
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Location of Service
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Date of Service
VEHICLE DESCRIPTION
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First time customer?
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Photograph of Vehicle Being Inspected
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Check Engine light on?
EXTERIOR LIGHTING
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Low Beams
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High Beam
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Brake Lights
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Signal Lights
- Drivers Front
- Drivers Rear
- Passengers Front
- Passengers Rear
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Reverse Lights
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Wiper Condition
- 100 percent
- 75 percent
- 50 percent
- 25 percent
- 10 percent
- requires immediate service
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Tire Condition
- 100 percent
- 75 percent
- 50 percent
- 25 percent
- 10 percent
- requires immediate service
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Belt Condition
- 100 percent
- 75 percent
- 50 percent
- 25 percent
- 10 percent
- requires immediate service
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Hose Condition
- 100 percent
- 75 percent
- 50 percent
- 25 percent
- 10 percent
- requires immediate service
Fluid Levels and Condition
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Oil leaks?
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Engine Oil Level
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Engine Flush Recommended?
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Transmission Fluid Condition
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Power Steering Fluid
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Engine Coolant
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Brake Fluid
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Differential Fluid
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Transfer Case Level
Post Service
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Service Guarantee
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Oil Level
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Oil on Dipstick<br>
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Next Service Date
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Signature of Technician