Corey’s Cars Mechanic Request Form

All sections must be completed for appointment to be confirmed

First Name:

Last Name:

Email:

Mobile Phone:

Home Phone:

Address:

City:

State:

Zip:

VIN:

Year:

Make:

Model:

Mileage:

Type of Service Requested

ACKNOWLEDGMENT AND CONSENT:

I hereby consent to receive text messages or phone calls from or on behalf of the dealer or their employees to the mobile phone number I provided above. By opting in, I understand that message and data rates may apply. This acknowledgement constitutes my written consent to receive text messages to my cell phone and phone calls, including communications sent using an auto-dialer or pre-recorded message. You may withdraw your consent at any time by texting "STOP".