TAT FAX SERVICE REQUEST FORM

****Complete all applicable information****
Print and fax this form to Toll Free 1-800-431-2906 or 615-595-6982
TAT Privacy Statement

Please Indicate How You Want to Receive Information: (place an "x" in one of the four selections).

Email____ US Mail_____ Fax______ or Telephone______

Date_____________ Time______________

Name_______________________________________________________________

Mailing Address______________________________________________________________

City:_____________________________State:_________Zip:__________________

EMail Address: ________________________________________________________

Telephone Number: (______)_____________________________________________

Fax Number: (______)______________________________________________

Vehicle Identification Number (VIN) - (17 digits on most vehicles) -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- (located on the left upper instrument panel -dash- and visible from outside the vehicle looking thru the windshield)

Year:________________ Make:__________________________

Model:________________________________________________

Engine Size:______________Transmission Type: Automatic:_____ Manual:_____

Fuel System: ( fuel injected, carbureted, diesel, etc. )_______________________

Air Conditioning: (Y/N)__________________

Optional Information (if necessary):________________________________________

Please send me information on:

 

Price for the Email, US Mail, and fax service is $19.95 per vehicle. This includes research and documents up to 10 pages. Each additional page will cost $1.75. A shipping and handling charge of $1.00 will be added to the US Mail cost.

Please contact me if the cost will be more than $_________________.

The price for live telephone information is $3.50 per minute. Just call 1-800-636-6414 or 615-595-6974 Monday-Friday, 7AM-7PM CST. Have your credit card # number available.

American Express/Visa/MC/Discover#: _____________________________________  Secure Card Number ______

Expiration Date: Month____________ Year___________

Billing address if different from shipping address: ______________________________

City _____________________ State ___  Postal Code/Zip ________

Fax form to: 1-800-431-2906 or (615)-595-6982.

TAYLOR AUTOMOTIVE TECH-LINE
153 Polk Place Drive
Franklin, TN 37064-5736
Phone: (615)-595-6974

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