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Since 1985
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Symptom Checklist

Your Contact Information
Will Not Be Used For Marketing!
Name*
First Last
Email*
Home Phone*
Work / Cell Phone
Best Way To Contact You
- Home Phone
- Work / Cell Phone
- Email
Your Vehicle Information
Vehicle Year*
Vehicle Make*
Vehicle Model*
Vehicle Mileage*
What Is The Symptom?*
After selecting the symptom(s) that apply to your vehicle below, you will be asked to answer more questions to get a better idea on what the problem is.
- Warning Lights Are On
- Vehicle Doesn't Start
- Vehicle Doesn't Run Correctly
- There's A Brake Problem
- There's A Steering Issue
- Heating or A/C Doesn't Work Properly
- The Vehicle Makes Funny Noises
- There's an Unusual Vibration
- There's Fluid Leakage

Is a warning light on?
If yes, please fill out the section below. If not, please continue on to the next section.
What light is on?
When is it on?
Outside Temperature?
Weather Conditions?
Temp of vehicle when it happens?
Comments

Is your vehicle having trouble starting?
If yes, please fill out the section below. If not, please continue on to the next section.
Doesn't Start
Occurance
Outside Temperature?
Weather Conditions?
Temp of vehicle when it happens?
Comments

Is your vehicle not running correctly?
If yes, please fill out the section below. If not, please continue on to the next section.
Problem
Occurance
Outside Temperature
Weather Conditions?
Conditions
Type of Driving?
Temp of vehicle when it happens?
Comments

Brake Problem?
If yes, please fill out the section below. If not, please continue on to the next section.
Problem
Occurance
Outside Temperature
Weather Conditions?
Conditions
Type of Driving?
Temp of vehicle when it happens?
Comments

Steering Problem?
If yes, please fill out the section below. If not, please continue on to the next section.
Problem
Occurance
Outside Temperature
Weather Conditions?
Conditions
Type of Driving?
Speed?
Temp of vehicle when it happens?
Comments

Heating and/or AC Problem?
If yes, please fill out the section below. If not, please continue on to the next section.
Problem
Occurance
Outside Temperature
Weather Conditions?
Temp of vehicle when it happens?
Comments

Vehicle Making Odd Noises?
If yes, please fill out the section below. If not, please continue on to the next section.
Noise Description
Noise Coming From
Occurance
Outside Temperature
Weather Conditions?
Conditions
Type of Driving?
Speed?
Temp of vehicle when it happens?
Comments

Do You Feel a Vibration in the Vehicle?
If yes, please fill out the section below. If not, please continue on to the next section.
Where do you feel it?
Occurance
Outside Temperature
Weather Conditions?
Type of Driving?
Speed?
Temp of vehicle when it happens?
Comments

Fluid Leaks?
If yes, please fill out the section below. If not, please continue on to the next section.
Location
Color of Fluid
Is there an odor?
Outside Temperature
Weather Conditions?
Temp of vehicle when it happens?
Comments

General Comments / Concerns
Please include any additional information above, then submit the form.
Email
This field is for validation purposes and should be left unchanged.

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83 Broad Street, Nashua New Hampshire 603-886-5800 | 419 Elm Street, Milford New Hampshire 603-249-5552
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