Vibration Customer Diagnostic Survey Form
Customer Name *
Your answer
Date *
MM
/
DD
/
YYYY
License Plate #
Your answer
VIN
Your answer
When the Concern Occurs
The concern starts at what vehicle speed... (km/hr)
Your answer
Describe the road conditions on which the concern occurs
If other, please describe
Your answer
The Concern Started
The Concern Started (odometer reading)
Your answer
The Concern Occurs
Have the tires been balanced?
Have the tires been rotated?
Were there any repairs performed prior to the condition occurring?
Please check the box that best describers the vibration you "feel"
Please check the box that best describers where you "feel" the vibration
If none of the above, please describe where you "feel" the vibration coming from.
Your answer
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