Sternberg Auto Service Department

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Contact Information

Name:

Company:

D.B.A.:

Address:

City:

State: Zip:

Day Phone:

Evening Phone:

Cell Phone:

Fax:

Email:

Preferred Contact: Work Phone Home Phone Cell Phone Email Fax Mail

Vehicle Information

Year: Make: Model: Mileage:

Unit #:

VIN #:

Job Type: Insurance Warranty Maintenence Repair/Mechanical Body Work Paint Billing Method: C.O.D. Credit Card Fleet Charge Sternberg Charge Account

Purchase Order Number:

Month: January February March April May June July August September October November December Day: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year: 2007 2008 2009 2010 2011 Time (hh:mm am/pm):

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