To help service your car better, please print out the worksheet below, fill it in and either fax it to us (217) 344-6662 or bring it in when you drop off your car.

Will your car:
____   Not crank or start?
____  Crank, but won’t start?
____  Start, but only after several attempts?

If your car stalls, does it do so:
____  Immediately after starting?
____  While in park?
____  When put in gear?
____  While idling?
____  During acceleration?
____  While driving at a steady speed?
____  While braking?
____  When vehicle comes to a stop?

Does your vehicle seem to idle:
____  normally?
____  too slowly?
____  to slowly while A/C is on?
____  roughly or unevenly?
____  too fast?
____  irregularly (alternately too fast or too slow)?


While running, does your vehicle:
____  run rough?
____  seem to lack power?
____  backfire?
____  surge or jerk?
____  misfire or cut out?
____  hesitate or lose power on acceleration?


Do you notice:
____  a gas or sulfer smell?
____  the Service Engine soon light on intermittently?
____  the Service Engine Soon light on consistently?
____  poor gas milage/fuel economy?
____  knocks, pings, or rattlings in the engine?


When shifting, does your vehicle:
____   shift too early or too late?
____  change gears apparently at random?

Does the brake pedal seem:
____  spongy?
____  hard?
____  soft?
____  too high?
____  too low?
____  to pulsate?
____  to work better when pumped?
____  to return to normal position too slowly?

Does the vehicle:
____  remain straight when stopped?
____  pull to the left only while braking?
____  pull to the right only while braking?

Do the brakes seem to:
____  grab?
____  lock up?
____  drag?
____  make noise?

if there is a brake noise, please describe here
____________________________________________
____________________________________________
____________________________________________

Has brake fluid been added in the last six months?
____  Yes
____  No

Have the brakes been serviced or adjusted in the last six months?
____  Yes
____  No

Is the dash brake light on?
____  Yes, consistently
____  Yes, intermittently
____  No, never

Does the vehicle drift or pull:
____  to the right?
____  to the left?

Under what conditions?
____  all the time
____  while braking

Please describe any other conditions under which this occurs:
____________________________________________
____________________________________________
____________________________________________

Do you feel a vibration while driving?
____  yes, consistently
____  yes, at speeds of _________
____  no

Are the front tires worn irregularly?
____  Yes
____  No

Are the rear tires worn irregularly?
____  Yes
____  No

Does the steering wheel rest in a straight position while driving?
____  Yes
____  No, to the right
____  No, to the left

Does the steering seem loose?
____  Yes
____  No

Do you notice unusual noises while going over bumps?
____  Yes
____  No

Do you notice any of these other symptoms?
____  excessive play in steering
____  steering wheel slow to return after cornering
____  suspension seems to bottom out
____  traction control dash light is on
____  vehicle sits unevenly
____  difficulty steering
____  shimmy or vibration: if so, where?
____________________________________________

Does the system seem to occur more in the following conditions?

____  cold days		____  hot days
____  wet/rainy days		____  at road speed
____  while accelerating		____  while decelerating
____  while braking		____  intermittently

Do you notice any of the following noises?

____  knocking		____  metal on metal
____  roaring		____  ticking
____  whining		____  squeaking
____  rattling		____  scraping
____  other		_____________________________

If so, can you tell approximately where it’s coming from?

____  engine compartment - if so,	right	or	left?	(circle one)
____  front axle, if so,	right	or	left?
____  rear axle, if so,	right	or	left?
____  passenger compartment
____  instrument panel
____  doors, if so, which door?	right	or	left?
	front	or	back?

How often do these noises occur?
____  consistently
____  frequently
____  intermittently
____  they have just started
____  since acquiring the vehicle

Is the A/C system cooling well?
____  Yes
____  No
____  Sometimes

Are the vents blowing air?
____  Yes
____  No
____  Only at speeds
____________________________________________
____________________________________________
____________________________________________

Are all the dash controls functioning normally?

Do the heater and defroster work OK?
____  Yes
____  No
____  Heater doesn’t work
____  Defroster doesn’t work

Is the A/C noisy when turned on?YesNo

Does the car stall or idle abnormally while A/C is on?YesNo

Does your car overheat?
____  Yes, consistently
____  Yes, intermittently
____  No, never

Has the A/C filter/dryer been replaced?YesNo

Has the A/C system been serviced, if so, how long ago?
____________________________________________

Do you notice any unusual smell when the A/C or heater is running?
If so, please describe the smell
____________________________________________
____________________________________________
____________________________________________