Chenier Motors Ltd,

1276 Riverside Dr PO Box 990
Timmins, ON P4N 7H6
T: 705-264-9528
Toll: 888-264-9528
F: 705-264-2832

Chrysler, Dodge & Jeep

Service Appointment

Please complete the form below to make your appointment.
We will contact you to confirm your appointment.

Title:
First Name:	*required
Last Name:	*required
Address:
City:
Postal Code:
Email Address:
Home Phone:
Work Phone:	Extension
	Please fill in your vehicles Year, Make and Model
Year
Make
Model
	Please fill out both date and AM or PM
1st Choice	* required* required
2nd Choice	* required* required
	Please describe the service to be performed.
Service #1	*required
Service #2
Service #3
Service #4
	How would you like us to contact you?
	Telephone: (day)
	Telephone: (evening)
	Email: (please provide email address above)
	Fax:
Please add any additional comments in this section so that we may serve you better.