Request Service Form

      Company Name

      Customer Name*

      Phone Number*

      E-mail*

      Is Pick-up / Delivery or On-Site Service Required? YesNo

      Car Manufacturer

      Serial Number

      Have you previously purchased from CGC?

      Billing Address*

      City*

      State*

      Zip Code*

      Electric or Gas Powered? ElectricGas

      Does the car currently run? YesNo

      Service Needed*

      Security Question

      Please check your spam / junk mail if you do not receive a response within 48 hours.