What is the transmission type?
Automatic   Standard

Is the check engine light on?
Yes   No

Any known error codes?
Yes   No    If yes, please list all: (Separated by Comma)

In the last six months have you had any service done on the: (Check all that apply)
Engine   Axles  Radiator   .Transmission    Other:

When was the last time the transmission was serviced?
Please choose Less than a week Less than a month Less than 6 months Less than a year More than a year Never Don't know

Does the battery run down?
Yes   No

Are you experiencing a delay or have trouble going into drive or reverse when cold?
Yes   No

Are you experiencing a delay or have trouble going into drive or reverse when hot?
Yes   No

Do you notice any noise or shifting problems when accelerating?
Yes   No

Do you notice any noise or shifting problems when at a constant speed?
Yes   No    If yes, at what mile per hour? MPH

How long have you had any of the above problems?
Please choose Less than a week Less than 1 month Less than 2 months Less than 6 months More than 6 months Don't know

How long have you owned the vehicle?
Please choose Less than a week Less than 1 month Less than 2 months Less than 6 months More than 6 months Don't know

IMPORTANT! Describe any other symptoms or conditions:

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