Please fill out the requested information below.
Supporting documenation can be sent in via this form, mailed, or faxed to our location.
(See mailing address and fax number below)

Items with a * are required information to help with the resolution process.

* Name:
* Primary Phone:
Seconday Phone:
* Email:
Location of Service:		Arizona, Phoenix, 3401 S. Greenway Rd. California, Rancho Cordova, 10655 Coloma Rd. Florida, Doral, 2379 NW 97th Ave. Florida, Lauderhill, 6520 Commercial Blvd. Florida, Miami Gardens, 3670 NW 183rd St. Florida, Oakland Park, 320 E. Prospect Illinois, Bradley, 998 N. Kinzie Ave. Illinois, New Lenox, 1500 W. Lincoln Hwy Indiana, St. John, 9540 Wicker Ave Iowa, Des Moines, 2723 Grand Ave. Michigan, Battle Creek, 1050 W. Columbia Ave. Michigan, Belleville, 51300 Huron River Dr. Michigan, Canton, 44744 Michigan Avenue Michigan, Canton, 5811 N. Canton Center Rd. Michigan, Clinton Township, 368 N. Gratiot Ave. Michigan, Clinton Township, 37663 Groesbeck Hwy. Michigan, Coldwater, 48 Division St. Michigan, Fenton, 16500 Silver Parkway Michigan, Grand Rapids, 5333 Plainfield Michigan, Jenison, 279 Baldwin St. Michigan, Lansing, 5551 S. Pennsylvania Ave. Michigan, Livonia, 33400 W. 7 Mile Rd. Michigan, Livonia, 36251 Five Mile Rd. Michigan, Madison Heights, 433 W. 12 Mile Rd. Michigan, Marshall, 126 West Drive N. Michigan, Monroe, 15396 S. Dixie Hwy. Michigan, Mt. Pleasant, 402 N. Mission Michigan, Novi, 24400 Novi Rd., Ste. 104 Michigan, Plymouth, 530 W. Ann Arbor Rd. Michigan, Southgate, 13045 Northline Rd. Michigan, St Clair Shores, 21900 Greater Mack Ave. Michigan, Sterling Heights, 2051 Eighteen Mile Rd. Michigan, Sterling Heights, 37538 Van Dyke Rd. Michigan, Waterford, 5100 Dixie Hwy. Michigan, Westland, 1338 S. Wayne Rd. Michigan, Woodhaven, 23979 Allen Rd. Michigan, Ypsilanti, 2555 Washtenaw Ave. Michigan, Zeeland, 8509 Heritage Dr.
* Date of Service:
* Invoice Number:
Make:
Model:
Year:
* Description of Issue:
Attach File:
		* Please do not attach file over 4 MB!
If available, we would like to have copies of other documentation regarding the issue.
These documents can be submitted here, mailed, or faxed.
Fax:(248) 994-0255
Mail: 27280 Haggerty Rd, Suite C-6 Farmington Hills, MI 48331
Thank you!
Auto-Lab Customer Service Department