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    New Customer Form

    Vehicle Registration Number*
    Please enter your vehicles registration plate.
    [text* registration]

    Vehicle Make/Model/Year*
    Please enter the Make, Model and Year of your vehicle.
    [text* makeModelYear]

    Contact Details
    Please enter the contact details of the person who we should contact and is authorised to make decisions and pay the bill for the vehicle
    First Name*
    [text* firstName]
    Last Name*
    [text* lastName]
    Mobile phone*
    [tel* mobileNumber]
    Home or Business Phone
    [tel homeNumber]
    Email*
    [email* email]

    Address
    Please enter your home or business address of the person who we should contact and is authorised to make decisions and pay the bill for the vehicle
    Home or Business Address*
    [text* address]
    Suburb*
    [text* suburb]
    City*
    [text* city]

    How did you find out about us?*
    Please choose one option below to tell us how you found out about us
    [select* marketing include_blank “Google” “Auto Super Shoppes” “VTNZ Hamilton Referred” “VTNZ Te Rapa Referred” “VTNZ Pukete Referred” “VTNZ Frankton Referred” “Friend – Referred” “Building Signage” “Facebook” “LED Sign out front” “Radio Ad” “Yellow Pages” “Previous Customer”]

    [group referred][/group]

    What type of work you need done?*
    Please tell us about the type of work you need done
    [textarea* work-needed]
    If you you have a WoF sheet detailing required repairs please either upload the files, email the files to tonyv@grimmermotors.co.nz, or leave them on the passengers seat
    [mfile upload-files filetypes:gif|png|jpg|jpeg|pdf limit:10000000]
    Have you or anyone else worked on this issue with your vehicle?*
    [radio previous-work “Yes” “No”]

    [group group-prev-work]
    Please tell us who worked on your car*
    [select* prev-work-person “Me” “Relative” “Friend” “Another Auto Repair Business” “Other”]

    Please give details of work done*
    [text* prev-work-done]
    [/group]

    Who will be paying for this work?*
    [select* who-pay include_blank “Me” “Mother” “Father” “Relative” “Friend” “Business” “Insurance” “Other”]

    Payment Method when picking up vehicle?*
    Grimmer Motors has a strict payment on pick up policy. How will you pay?
    [select* payment-method include_blank “Internet Banking” “Genoapay (+4% Grimmer Motors Admin fee)” “Credit Card (+3% Grimmer Motors Admin fee)”]

    I agree to all the terms and conditions above
    [checkbox* agree-payment “I Agree”]

    Contact Method when vehicle is ready?*
    How would you like us to contact you when your vehicle is ready to be picked up?
    [select* contact include_blank “Please call my mobile when vehicle ready” “Please call my landline when vehicle ready” “Please txt me when vehicle is ready” “Please email me when vehicle is ready”]

    Accept Grimmer Motors Terms and Conditions*
    I understand that parts and services remain the property of Grimmer Motors 2015 Ltd until paid for in full, and interest, late payment and collection fees may be added to invoices.
    I understand I am liable for storage costs at $25 per day, 24 hours after I am informed that the car is ready to be uplifted if I do not return to uplift the vehicle or pay my account causing the vehicle is held on site.
    I understand that I/We give authority for Grimmer Motors 2015 Ltd to hold my personal information and authorise any person or company to provide Grimmer Motors with information to determine my whereabouts and my credit worthiness.
    By clicking “Submit” on this form you are agreeing for Grimmer Motors to send you Follow Up reminders for repair, maintenance or diagnostic items your vehicle requires, plus occasional newsletters and promotions via text or email.

    [checkbox* agree “I Agree”]

    [submit “Submit”]

    1
    Grimmer Motors Hamilton New Customer Form
    wordpress@grimmermotors.co.nz
    office@grimmermotors.co.nz
    Registration: [registration]
    Make/Model/Year: [makeModelYear]
    First Name: [firstName]
    LastName: [lastName]
    Mobile: [mobileNumber]
    Home Or Biz Phone: [homeNumber]
    email: [email]
    Address: [address]
    Suburb: [suburb]
    City: [city]
    Marketing: [marketing]
    Referral: [referral]
    Work Needed: [work-needed]
    Previous Work: [previous-work]
    Previous Work Person: [prev-work-person]
    Previous Work Details: [prev-work-done]
    Payer: [who-pay]
    Payment Method: [paymnet-method]
    Payment Agreement: [agree-payment]
    Contact Method: [contact]
    Term Agreement: [agree]
    Reply-To: [email]
    [wof-sheet]

    1

    Grimmer Motors Hamilton “[your-subject]”
    Grimmer Motors Hamilton
    [your-email]
    Message Body:
    [your-message]


    This e-mail was sent from a contact form on Grimmer Motors Hamilton (https://grimmermotors.dev.voyle.nz)
    Reply-To: tonyv@rennacs.com

    Thank you for your message. It has been sent.
    There was an error trying to send your message. Please try again later.
    One or more fields have an error. Please check and try again.
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    Phone: 07 855 2037

    Email: office@grimmermotors.co.nz

    Address: 998 Heaphy Terrace, Fairfield, Hamilton

    Get your car repaired today
    Book Now
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