Service Request Form
Vehicle Information
*
Manufacturer:
*
Year:
*
Model:
Miles:
VIN Number:
Service Information
*
Type of Service Needed:
Preferred Appointment Time:
Select a day
Sat 07/05/08
Mon 07/07/08
Tue 07/08/08
Wed 07/09/08
Thu 07/10/08
Fri 07/11/08
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Tue 07/15/08
Wed 07/16/08
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Sat 07/19/08
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06:00 PM
Evening drop-off
Alternate Appointment Time:
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Sat 07/05/08
Mon 07/07/08
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Thu 07/10/08
Fri 07/11/08
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Tue 07/15/08
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Sat 07/19/08
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07:00 AM
08:00 AM
09:00 AM
10:00 AM
11:00 AM
12:00 PM
01:00 PM
02:00 PM
03:00 PM
04:00 PM
05:00 PM
06:00 PM
Evening drop-off
Contact Information
*
Name:
*
Email:
Home Phone:
Day Phone:
Cell:
Preferred Contact:
Phone Morning
Phone Midday
Phone Evening
Email
Cell
*
Address:
City:
State:
Zip:
*
These fields are required
Hill Country Ford
1200 Hwy 84 • PO Box 289 • Goldthwaite, Texas 76844
Main Phone 325-648-2296 • Toll Free 800-588-9844 • Email:
Sales Dept
Sales 8am-6pm M-F • Sat 8:30am-2pm
Service 7:30am - 6:00pm M-F • Closed SAT
Parts 7:30am - 6:00pm M-F • Closed SAT
Late service pickup with prior arrangement
Night (afterhours) service drop-off available for next day service.
Privacy Notice
Friday July 04 2008
971844
