City Nissan Lower Hutt - 340 High Street, Lower Hutt - Phone: (04) 566 8668 - Fax: (04) 566 8444

 
Fields marked with * are required.

Driver
Title
If other, please specify
First Name*
Surname*
Address*

Registered Owner (if different)
Title
If other, please specify
First Name
Surname
Address
Home Phone Number
Daytime Phone Number
Mobile Phone Number
Email*
How would you prefer us to contact you?
Registration Number*

Vehicle Description:

(If we have serviced your vehicle before you do not need to complete this section.)
  Model  
  Make  
  Year of Manufacture  
  Kilometers Travelled  
  Engine Size (cc rating)  
  Auto or Manual Auto
Manual
  Petrol or Diesel Petrol
Diesel
WOF required Yes
No
Mobile or Workshop Service

 Mobile
Workshop
If Mobile Service, address to perform service
If workshop scheduled service, do you want to wait until your service is finished

 Yes
No
I require a Service Loan Vehicle (1)

 Yes
No
Date and time to be booked in or mobile service to attend
I will be paying by (2) Cash/Eftpos
Credit Card
Fleet Card
If Fleetcard, please specify
If other, please specify
Description of service work required

(1) Note - Provision of service loan vehicles is subject to availability. All service loan vehicle customers are required to sign an insurance waiver form that makes them liable for the first $2,000 of any damage caused to a service loan vehicle whilst in their possession.

(2) Note - credit accounts will not be available unless arrangements have been made prior to collection. Contact the City Nissan Service Manager at the workshop nearest to you for further details. No vehicle will be release until payment has been made in full or prior credit arrangements have been made. City Nissan reserves the right to grant or refuse credit at its sole discretion.