Eastgate Ford - Service Request Form

Location:
350 Parkdale Ave. N.,
Hamilton, Ont. L8H 5Y3
Phone: (905) 547-3211
Fax: (905) 547-8286

Please enter your contact information
* Name:
* Address:
* City:
* Province:	Postal Code:
Telephone:	( ) - (day)
Telephone:	( ) - (evening)
Fax:	( ) -
Email:

Please enter your vehicle information below
* Make:	* Model:	* Year:
VIN:

Please enter appointment information below
Description of Problem:
Requested Appointment Date:
Requested Appointment Time: specify AM/PM
Shuttle Bus Required: