Diagnostics Worksheet

Fill out form online - print and fax, mail or bring with you at time of appointment.

Lancer Service, Inc.
270 E. 8th St.
St. Paul, MN 55101
Fax 651.224.7431 Phone 651.224.0267


* = Required Fields

Customer Info......

First & Last Name *
Street Address *
City *
State *
Zip Code *
Phone Number *
Alt. / Cell Phone
Email Address

Vehicle Information......

Year
Make
Model
Engine (if known)
License
Color
VIN (If Known)
Type
Mileage

Drive Characteristics - Symptoms - Description of Problem (check all that apply)

Starting Problems
Engine Quits/Running Problems
Poor Idling Conditions
Poor Running Conditions
Auto Transmission Problems
Poor Handling
Noise Problems
Odor Problems
Problem Frequency
Usually Occurs
Engine Temp.
Vehicle Speed
Driving Conditions
Driving Habits
Typical Driving Distance
Octane Used
Gas Brand
Outside Weather
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      651.224.0267