Customer Detail Form

Thank you for choosing Gold Coast Car Electrics & Mechanical. If you could confirm your booking in advance, our team will be ready to assist you. Additionally, completing the customer detail form will streamline the check-in process. We look forward to meeting you soon.

I am an existing customer

Name*

Contact Number*

Email address*

Street Address*

State / Province*

City*

ZIP / Postal Code *

Confirm Booking Date **

Confirm Drop Off Time **

Registration Number*

Make*

Model*

Main Complaint*

Where did you find us?*

Terms & Conditions

I agree to receive email updates on New Product Announcements, Gift Ideas, Special Promotions, Sales and More. *

Yes

This field should be left blank