Appointment Request Form

Please complete to request an appointment

Note: Online appointments require confirmation.

Online appointment requests must be confirmed a minimum of one business day in advance (e.g. Monday morning appointments need to be confirmed before closing Friday).

We will phone or email your confirmation.

** Short notice appointments should be made by phone (772) 283-4610 **

Your Name: *

Please enter your first and last names.

Phone Number: *

Phone number where you can be reached. Special instructions (best time to call, etc.) can be provided in Comments box at bottom of this form.

E-mail Address:

Preferred Contact Method: *

e-mail

phone

What is your preferred method for us to contact you to confirm your appointment?

Appointment Date

NOTE: Online Appointments must be requested at least 1 business day (24hrs) in advance (e.g. Monday morning appointments must be requested and confirmed before closing on Friday). Providing more than one date can ease the scheduling of your appointment.

We are closed Saturday and Sunday.

1st Preferred Date: *

2nd Preferred Date:

3rd Preferred Date:

Drop Off Time: *

'Drop in and wait' times are 8:00am and 1:00pm

Vehicle Year:

Vehicle manufacturer: *

If 'Other', add vehicle manufacturer to 'Model' field.

Vehicle - other: *

NOTE: If your vehicle make is not listed please enter make and model.

Acura models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Acura model - other: *

Please enter your vehicle model if not listed above.

Audi models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Audi model - other: *

Please enter your vehicle model if not listed above.

BMW models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

BMW model - other: *

Please enter your vehicle model if not listed above.

Buick models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Buick model - other: *

Please enter your vehicle model if not listed above.

Cadillac models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Cadillac model - other: *

Please enter your vehicle model if not listed above.

Chevrolet models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Chevrolet model - other: *

Please enter your vehicle model if not listed above.

Chrysler models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Chrysler model - other: *

Please enter your vehicle model if not listed above.

Daewoo models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Daewoo model - other: *

Please enter your vehicle model if not listed above.

Dodge models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Dodge model - other: *

Please enter your vehicle model if not listed above.

Ford models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Ford model - other: *

Please enter your vehicle model if not listed above.

GMC models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

GMC model - other: *

Please enter your vehicle model if not listed above.

Honda models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Honda model - other: *

Please enter your vehicle model if not listed above.

Hummer models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Hummer model - other: *

Please enter your vehicle model if not listed above.

Hyundai models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Hyundai model - other: *

Please enter your vehicle model if not listed above.

Infiniti models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Infiniti model - other: *

Please enter your vehicle model if not listed above.

Isuzu models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Isuzu model - other: *

Please enter your vehicle model if not listed above.

Jaguar models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Jaguar model - other: *

Please enter your vehicle model if not listed above.

Jeep models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Jeep model - other: *

Please enter your vehicle model if not listed above.

Kia models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Kia model - other: *

Please enter your vehicle model if not listed above.

Land Rover models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Land Rover model - other: *

Please enter your vehicle model if not listed above.

Lexus models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Lexus model - other: *

Please enter your vehicle model if not listed above.

Lincoln models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Lincoln model - other: *

Please enter your vehicle model if not listed above.

Mazda models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Mazda model - other: *

Please enter your vehicle model if not listed above.

Mercedes Benz models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Mercedes Benz model - other: *

Please enter your vehicle model if not listed above.

Mercury models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Mercury model - other: *

Please enter your vehicle model if not listed above.

Mini models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Mini model - other: *

Please enter your vehicle model if not listed above.

Mitsubishi models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Mitsubishi model - other: *

Please enter your vehicle model if not listed above.

Nissan models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Nissan model - other: *

Please enter your vehicle model if not listed above.

Oldsmobile models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Oldsmobile model - other: *

Please enter your vehicle model if not listed above.

Plymouth models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Plymouth model - other: *

Please enter your vehicle model if not listed above.

Pontiac models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Pontiac model - other: *

Please enter your vehicle model if not listed above.

Porsche models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Porsche model - other: *

Please enter your vehicle model if not listed above.

Saab models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Saab model - other: *

Please enter your vehicle model if not listed above.

Saturn models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Saturn model - other: *

Please enter your vehicle model if not listed above.

Scion models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Scion model - other: *

Please enter your vehicle model if not listed above.

Smart models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Smart model - other: *

Please enter your vehicle model if not listed above.

Subaru models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Subaru model - other: *

Please enter your vehicle model if not listed above.

Suzuki models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Suzuki model - other: *

Please enter your vehicle model if not listed above.

Toyota models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Toyota model - other: *

Please enter your vehicle model if not listed above.

Volkswagen models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Volkswagen model - other: *

Please enter your vehicle model if not listed above.

Volvo models: *

If your vehicle model is not listed please select "- Other -" and enter in the "Model - Other" field below.

Volvo model - other: *

Please enter your vehicle model if not listed above.

Vehicle color:

Vehicle Licence Plate Number:

Comments:

Please add any special instructions or requests.

How did you find out about us?: *

Find us - internet other:

It helps greatly if we know where our customers come from. Please let us know which website you found us on.

Who recommended us?:

We like to reward customers who recommend us to their friends. Please tell us who told you about us.

Can we add you to our Newsletter email list?: *

We periodically send out information about upcoming specials, coupons, or car care tips. Your privacy is assured and your email address will not be shared or used for any other purpose. You can opt-out from receiving these emails at any time.

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