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Starting Problems: 

{} Will not Crank      {} Cranks, but Won't Start     {}  Starts, but Takes a Long Time

Engine Problems Stalling:   {}  Right after Starting   {} When put in Gear     {} Right after Vehicle comes to a Stop    {} During Steady Driving Speed     {}While Idling         {}During Acceleration    {}When Parking

Poor Idling Conditions: 

{}  Too Slow at All times    {} Too Slow with A/C on    {} Too Fast    { }Rough or Uneven    {} Fluctuates Up/Down     {} On  First Start Up

Poor Running Conditions: 

{} Runs Rough    {}  Lacks Power    {}  Hesitates or Stumbles on Acceleration    {} Buck and Jerks             {} Engine Knock, Ping, or Rattle    {}  Backfires    {}  Poor Fuel Economy     {} Misfires or Cuts Out   {} Surges and / or Chugs    {}  Dieseling or Run On    {}  Engine Light Always On    {} Engine Light  On Occasionally    {}  Fuel, Gas, or Sulfur Smell

Auto Transmission Problems:   

 {} Improper Shifting - Early     {}Improper Shifting - Late   {}Changes Randomly on its Own     {}  Vehicle does not Move when in Gear

Poor Handling:   

{}  Pulls to Right     {}Pulls to Left     {}Hard Steering     {}Vehicle Shakes and/or Vibrates while Moving

Noise Problem:   Explain:  

Odor Problems:   Explain: 

Problem Frequency:        {} Always      {}Often      {}Occasionally 

Usually Occurs:      {}Morning      {} Afternoon      {}Anytime   

Engine Temperature:     {} Cold     {}Warm      {}Hot    

Vehicle Speed:    {} Low        {} Cruising        {}High 

Outside Weather:   {}Cold    {}Warm    {}Hot .  {}Wet     {}Fog        {}Snow  {}Dusty/Dirt    {}Dry     {}Humid  

Driving Conditions During Occurance: 

Short - Less then 2 miles   {}2-10 miles    {} over 10 miles    {}Stop / GO     {} While Turning     {}While Braking     {} At Gear Engagement    {}With AC Operating     {}While Headlights are on        {}During Acceleration    {}Mostly Downhill     {} Mostly Uphill     {}Mostly Level     {} On Curves     {}Rough Road  

Driving Habits:    {}Drive hard before Engine Warm   {}Allow Engine to Warm    {}Mostly City Driving     {}Highway      {}Park Vehicle Inside        {} Park Vehicle Outside

Miles Per Day:         {}Less than 10   {} 10-50miles per day    {}More than 50   

Fuel Octane:   {} Low     {}Mid      {}High