What is the transmission type?
Automatic   Standard

Is the check engine light on?
Yes   No

In the last six (6) months have you had any service done on the: (Check all that apply)
Engine   Axles  Radiator   .Transmission    Other:

When was the last time the transmission was serviced?
Please choose Less than a month Less than 6 months Less than a year More than a year Never Don't know

Does the battery run down?
Yes   No

Experiencing a delay or have trouble going into drive or reverse when cold?
Yes   No

Experiencing a delay or have trouble going into drive or reverse when hot?
Yes   No

Any noise or shifting problems when accelerating?
Yes   No

Any noise or shifting problems when at a constant speed?
Yes   No    If yes, at what mile per hour? MPH

How long have you had any of the above problems?
Please choose Less than a week Less than 1 month Less than 6 months More than 6 months Don't know

How long have you owned the vehicle?
Please choose Less than 6 months More than 6 months

IMPORTANT! Describe any other symptoms or conditions:

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