Colletts Automotive Schedule Form

"Auto Repair By People Who Care"

Foreign & Domestic Cars and Trucks

822 North Main Morton IL 61550 309-263-7932

Please fill out this form as completely as possible to better serve you. Items in red are required for processing. We will contact you immediately to schedule your service requirements.

First Name:
Last Name:
Company:
Address:
Address (cont):
City:
State:
Zip:
Phone Number:
Fax Number:
Email:

Make of Vehicle (Ford, Nissan, etc.):

Year Of Vehicle:

Vehicle Model (F150, Bonneville, etc.)

Please give us a description of the problem you are having with the vehicle, or what routine maintenance you require. Please be as specific as possible.

I would like to request an appointment on          , at

I understand that you will meet this time as closely as possible.

Please confirm my appointment via

When you have completed this form, please hit the "Submit" button.

Any information you wish to change? Hit the "Reset" button and make your changes. Thanks!