Name *

First Name

Last Name

Do we have service records for this vehicle?

Yes

No

My vehicle's "Check Engine" light (check all that apply if applicable)

Stays on while driving

Flashes while driving

Comes on intermittently while driving

Never comes on while driving

This happens when engine is warmed up

This happens when engine is cold

When starting, my vehicle (Check all that apply)

Will not start

Is difficult to start

Starts and dies

Starts normally

This happens when engine is warmed up

This happens when engine is cold

While idling, my vehicle (Check all that apply)

Will not idle

Idles roughly

Surges up and down

Idles too low

Idles too high

Idles normally

This happens when engine is warmed up

This happens when engine is cold

While driving, my vehicle (check all that apply)

Hesitates

Lacks power (sluggish)

Stalls when stopping

Stops running while cruising

Cuts out

Surges

Backfires

Pings (Sounds like popping corn)

Smokes excessively

Black smoke

Blue smoke

White smoke

Has a fuel or gas odor

Vibrates excessively

Stumbles

Runs too cold

Runs too hot

Appears to run normally

Other symptoms (Check all that apply)

Transmission shifts

Poor fuel mileage

Emissions test failure or "rotten egg" odor

Conditions occur at this time

Morning

Midday

Evening

Night

Conditions occur at this speed

Idle

Low speed

Stop and Go

Highway

High speed

Acceleration

Deceleration

Conditions occur at this driving distance

Less than 2 miles

From 2-10 miles

More than 10 miles

Environmental Conditions

Cold weather

Hot weather

Wet/raining

Snow

Fog

Dirt/dust

Engine Conditions

Engine cold

While turning

With headlights on

Engine hot

While braking

With AC on

All Temperatures

When shifting

Has your vehicle been repaired recently?

Yes

No

Do you have documentation to help us see the repairs that were performed?

Yes

No

Has the engine be recently washed?

Yes

No

Has there been a recent sound system installation?

Yes

No

Are there any electrical accessories that do not work?

Yes

No

Please check all that apply:

Start cold engine and drive immediately

Start cold engine and allow to warm up before driving

Mostly highway driving

Mostly city (Stop and Go)

Mixed highway and city

Park in Garage

Last fill up date:

MM

DD

YYYY

Did the problem occur after a fuel purchase?

Yes

No

Does anyone else drive the vehicle?

Yes

No

If yes, have they also experienced the problem?

Yes

No

Does the temperature gauge ever show overheat or very low after driving for 30 minutes of more?

Yes

No