Customer details
Full Name:
Phone Number:
Email Address:


Vehicle details
Make and Model:
Fleet No:
Registration:
Work Required (i.e. general service, tyres etc):


Booking details
Store Name:

A 5km limit for pick-up and delivery applies (from Kmart Tyre and Auto Service centres).
Store Location:
Store Address:
Preferred service date. Please provide minimum 5 days' notice:
 
Pick Up Time:
Drop Off Time:
If pick up/drop off is required please confirm pick up address:
Other instructions or comments: