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NEW FEATURE!
Dealer – On Lot
Service Request
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Dealer We Owe Request
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Dealers
NEW FEATURE!
Dealer – On Lot
Service Request
IMPROVED!
Dealer We Owe Request
Dealer Pay
Dealer Client Referral
Client Pay
Services
Book Appointment
Service Availability
My Account
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Dealer Client Referral Request
Dealer Client Referral Request - Client Pay
Step
1
of
3
- Dealer Info
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Important Notice
This form is to be used only when referred Client will be paying for service. Please DO NOT USE this form when Dealer will be paying for clients bill.
Do not use this form for any other purposes - otherwise service may be delayed.
Referring Dealer Information
Referring Dealer Name
*
Dealer City
*
Dealer State
*
Delaware
District Of Columbia
Maryland
New Jersey
Pennsylvania
Virginia
Your Name
*
First
Last
Your Phone #
*
Your Email
*
Client Pay Or Dealer Pay?
*
Client Pay
Dealer Pay
Please Use Dealer We Owe Request - For Dealer Pays
We noticed that you selected "Dealer Pay" but your current page you are on is for "Dealer Referral Requests" please use the following link below for requesting service for your client if your dealership will be paying for bill:
CLICK HERE TO REQUEST - Dealer We Owe - Dealer Pay
The following link will allow you to request service to your client; on behalf of your dealership.
Client Info
Client Name
*
First
Last
Client Primary Phone #
*
Client Secondary Phone
Client Vehicle Information
Vehicle Year
*
Select Vehicle Year
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Vehicle Make
*
Select Vehicle Make
Acura
Audi
BMW
Buick
Cadillac
Chevrolet
Chrysler
Dodge
Fiat
Ford
Genesis
GMC
Honda
Hummer
Hyundai
Infiniti
Isuzu
Jaguar
Jeep
Kia
Land Rover
Lincoln
Lexus
Maserati
Mazda
Mercedes
Mercury
Mini
Mitsubishi
Nissan
Oldsmobile
Pontiac
Saab
Saturn
Scion
Smart
Subaru
Suzuki
Tesla
Toyota
Volkswagen
Volvo
Vehicle Model
*
Type Of Service Requesting
What type of service does client need?
*
All Keys Lost - Key Origination Service
Need Remote (Provided/Programmed)
Key (Provided/Programmed)
Not Sure
Other
Please Explain What Service Your Client Needs
*
Terms Of Agreement
Terms Of Agreement
*
Requestee agrees that they have permission to request service. I understand and agree to the above terms and conditions, and are authorized to order work on behalf of the above company and/or person. I understand by agreeing I am giving Delaware Auto Keys permission to contact client on behalf of requested services.
I agree to the terms of agreement.
*
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