2340 Dairy Road, Lancaster Pa. 17601
(717) 898-2552 • SINCE 1928 •
M-F 7:30am-5:00pm E.S.T

Request For Service

Please fill out this form and then print it out and bring this and your coupon (next page) along with you when you come in.

*Name
Organization
Address
City
State
Zip/Postal Code
*Phone
*Email
Would you like a quote
before the repair?
*Car Make
*Car Model
*Car Year
How did you hear
about us?
Please state the specific nature of the problem.
 
Email Powls: powlspeedo@aol.com