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MOBILE HILLS AUTOMOTIVE
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Intake form
Help us serve you better
Name
*
Email address
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What type of service do you require?
Please select at least one option.
Vehicle Inspection
Maintenance
Repair
Pre-Purchase Inspection
What is your vehicle make?
What is your vehicle model?
What year is your vehicle?
What is your vehicle's registration number?
What is the current mileage of your vehicle?
Do you have any specific concerns or issues with your vehicle?
Preferred date for service appointment?
Preferred time for service appointment?
How did you hear about us?
Select
Search Engine
Social Media
Word of Mouth
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Which service or services are you interested in?
Please select at least one option.
Pre purchase inspection
Maintenance services
Engine diagnosis
Additional questions or comments
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