Please provide us with following information so that we could contact you for a diagnosis and suggestions for your car.

Thank You!
Name:
E-mail:
Phone:
Year:
Make:
Model:
Transmission: Auto Standard    
Mileage:
Does your car stop ok?


    

Yes

 

  

No Sometimes
The brake pedal seems   Hard Soft Too high
 

 

 

Too low

 

 

Spongy Return to slowly
Does the vehicle


 

Stop straight


  

Pull left Pull right
Does the brakes


   

Grab


 

Lock Make noise
The emergency brake


 

Seldom used

 

  

Works Ok Does not work
Has brakes fluid been added in the last eight months? Yes

 


  

No  
Have the brakes been flushed and bled in the last six months?


  

Yes

 

 

  

No  
Is dash brake light on?


  

Yes

 

 

No  
Last brake service or repair?


 

3 months

 

 

6 months Longer
 

 

Other Problems
or
Comments: