Customer Diagnostic Survey Form
REAR WHEEL DRIVE TRANSMISSION
Client Name: ____________________________ Date: ____________________
Car Make/Model:____________________________ Licence #: ________________
DEFINE THE PROBLEM… ROAD TEST…
DESCRIPTION Is a road test really necessary? __Yes __No
If yes, please explain why| ______________
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Condition present when hot? ___ Yes __ No
Condition present when cold? ___ Yes __ No
Is the condition evident now? ___ Yes __ No
Is the condition intermittent? ___ Yes __ No
Has the transmission been
Previously repaired? ___ Yes __ No
Does the vehicle pull a trailer? ___ Yes __ No