On-Line Brake System Questionnaire

On-Line Brake System Questionnaire


Your Contact Information
Full name:
Daytime phone:
Evening phone:
Email address:

Your Vehicle Information
Year:
Make:
Model:
Engine size:

Service Information
Does the vehicle stop OK?	Yes No Sometimes
Is the brake pedal:	OK Hard Soft High Low Spongy Pulsating Chattering Return too slowly Work better when pumped
Does the vehicle:	Stop straight Always pull in one direction Pull left when braking Pull right when braking

Do the brakes:	Grab Drag Make noise Lock at times
Emergency/park brake:	Works OK Does not work properly Seldom used
Has brake fluid been added ?	Yes No
	If yes, when
Is the dash brake light on?	Yes No