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Date: |
Name: |
Invoice# |
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Year: |
Make: |
Model: |
Engine: |
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Mileage: |
V. I. N. |
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¨ Vehicle pulls right – When __________ |
¨ suspension bottoms out |
¨ Sits uneven |
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¨ Vehicle pulls left – When ___________ |
¨ Leans or sways in corners |
¨ "Dog" tracks |
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¨ Steering wheel vibrates at _______ MPH |
¨ Brake light on |
¨ ABS light on |
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¨ Excessive play in steering |
¨ Traction control light on |
¨ Soft ride |
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¨ Erratic steering when braking |
¨ uneven tire wear |
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¨ Poor steering wheel return after cornering |
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Hard to steer |
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Shimmy/vibration check box below for location |
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¨ Effort |
¨ Wanders |
¨ Front |
¨ Rear |
¨ Don't know |
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¨ Steering wheel off center |
¨ Seat |
¨ Floor |
¨ Other |
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¨ Cold days |
¨ Hot days |
¨ Wet / rain |
¨ All the time |
¨ Intermittent |
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¨ Parking maneuvers |
¨ At road speed |
¨ Accelerating |
¨ Decelerating |
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EXPLAIN: ________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
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¨ Engine compartment |
¨ Left |
¨ Right |
¨ Center |
¨ Don't know |
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¨ Front suspension |
¨ Left |
¨ Right |
¨ Center |
¨ Don't know |
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¨ Rear suspension |
¨ Left |
¨ Right |
¨ Center |
¨ Don't know |
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¨ Passenger compartment |
¨ Left |
¨ Right |
¨ Center |
¨ Don't know |
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¨ Instrument Panel |
¨ Left |
¨ Right |
¨ Center |
¨ Don't know |
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¨ Doors |
¨ Left |
¨ Right |
¨ Center |
¨ Don't know |
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¨ Rear seat area |
¨ Console |
¨ Other:_________________________________ |
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| ¨ Knocks |
¨ Hard metal |
¨ Light metal | ¨ Roars | ¨ Ticking | ¨ Whine |
| ¨ Squeak |
¨ Rattles |
¨ Scraping | ¨ Other |
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¨ Continuous |
¨ Often |
¨ Intermittent |
¨ Just started |
¨ Since new |
| ¨ All the time | ¨ Hard throttle | ¨ Hot days | ¨ Heavy bumps |
| ¨ Speed | ¨ Light throttle | ¨ Cold days | ¨ Light bumps |
| ¨ RPM | ¨ Decelerate | ¨ Humid or rainy | ¨ Smooth pavement |
| ¨ Only moving | ¨ Steady speed | ¨ Temperature | |
| ¨ On turns | ¨ Idle in gear | ||
| ¨ Braking | ¨ Idle out of gear |
EXPLAIN: _______________________________________________________________________
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