Service Appointment

RED TITLED BOXES REQUIRE INFORMATION

Please fill out the information required to contact you.
First Name:		Last Name:
Address:		City:
Province:	Alberta British Columbia Manitoba New Brunswick New Foundland Nova Scotia Northwest Territories Ontario Prince Edward Island Quebec Saskatchewan Yukon	Postal Code:
Phone: (day)		Fax:
Phone: (evening)		E-mail:
Contact by:	E-mail    Phone (day)    Phone (evening)    Fax

Please fill out a preferred date & time for your Service Appointment.
First choice:	Date		Time Morning Noon Afternoon
Second choice:	Date		Time Morning Noon Afternoon

Please fill out the Make and Model of your vehicle.
Year:		Did you purchase your vehicle from us or have you had your vehicle serviced at Westgate in the past?
Make:
Model:		Yes    No

Requested Maintenance
	Lube, Oil and Filter	4 Wheel Alignment
	Semi-Annual Maintenance Service (Includes Tire Rotation)	Transmission Service
	Coolant Flush	Engine Shampoo

Please describe other service requested.

PLEASE NOTE: We will contact you to confirm your appointment.