Appointment Request Form
Use this form to request a service appointment.
Call us for Monthly Service Coupon Savings
Vehicle Information
*Manufacturer:
*Year:
*Model:
Miles:
VIN Number:
Service Information
*Type of Service Needed:
*Preferred Appointment Time:
*Alternate Appointment Time:
Contact Information
*Name:
*Email:
*Home Phone:
*Day Phone:
Fax:
Preferred Contact:
*Address:
City:
State:
Zip:
*These fields are required
Emerald Mitsubishi
383 Goodpasture Island Road
Eugene, OR 97401		 Phone: (541) 342-6600
Fax: (541) 344-0400
E-Mail: emeraldcars@aol.com