LexBrodies

Please complete the form below for your Air Conditioning visit:

Make

Model

Year

Name

Middle Name

Last Name

Cellphone

Email

Is the air conditioner working?

Yes

No

How long has been broken?

N/A

Under a year

Over a year

When was the last time it was checked, serviced, or repaired?

Never

Under a month

Over a month

Over a year

What was done to it?

Nothing, everything was okay

Added refrigerant

Replaced a component

A dye was injected into it

A stop leak was added into the system

How is the AC performing?

Blows cold

Blows cool but not cold

Blows cold then blows warm

Blows warm or hot air

Water drips onto the passenger floor

Have you ever replaced the cabin air filter?

Yes

No

Do all the fan speeds work?

Yes

No

Do all the AC control modes work?

Yes

No

Does the AC make noise?

No

Yes, noise from under the hood

Yes, noise from inside the passenger compartment

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