Vibration Customer Diagnostic Survey Form
Customer Name *
Date *
MM
/
DD
/
YYYY
License Plate #
VIN
When the Concern Occurs
Clear selection
The concern starts at what vehicle speed... (km/hr)
Describe the road conditions on which the concern occurs
If other, please describe
The Concern Started
Clear selection
The Concern Started (odometer reading)
The Concern Occurs
Clear selection
Have the tires been balanced?
Clear selection
Have the tires been rotated?
Clear selection
Were there any repairs performed prior to the condition occurring?
Clear selection
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.
Submit
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