Dealer On Lot Service Request

Important Notice
This form is to be used by authorized Dealer Employees only. Requesting ON-LOT services for Dealer lot vehicles.

Do not use this form for any other purposes - otherwise service may be delayed.
Your Dealer Info
Requesting Dealer Name*
Dealer City*
Dealer State*
Your Name*
First Last
Your Phone #*
Your Email*
Your Position Title
Client Pay Or Dealer Pay?*
- Client Pay
- Dealer Pay
Please Use Dealer Client Referral Request

We noticed that you selected "Client Pay" but your current page you are on is designated for "Dealer Pay" only. Please use the following link below for requesting service for your client when client will be paying for bill:

CLICK HERE TO REQUEST - Client Pay - Dealer Referral

The following link will allow you to refer service to your client; on behalf of your dealership.

Lot Vehicle Info
Vehicle Year*
Vehicle Make*
Vehicle Model*
Stock #
VIN # (Last Six)*
How do you start this vehicle?*
- Insert Key - Twist/Start Key
- Press Button On Dash - Proximity Key
- Other - Not sure
What type of service do you need?*
- All Keys Lost - Key Origination Service
- Need Remote (Provided/Programmed)
- Key (Provided/Programmed)
- Other
Please Explain Your Service Needs Below:*
Would you like to add a second lot vehicle?*
- Yes
- No

Second Lot Vehicle
Vehicle Year*
Vehicle Make*
Vehicle Model*
Stock #
VIN # (Last Six)*
How do you start this vehicle?*
- Insert Key - Twist/Start Key
- Press Button On Dash - Proximity Key
- Other - Not sure
What type of service do you need for vehicle?*
- All Keys Lost - Key Origination Service
- Need Remote (Provided/Programmed)
- Key (Provided/Programmed)
- Other
Please Explain Your Service Needs Below:*
Would you like to add a third lot vehicle?*
- Yes
- No

Third Lot Vehicle
Vehicle Year*
Vehicle Make*
Vehicle Model*
Stock #
VIN # (Last Six)*
How do you start this vehicle?*
- Insert Key - Twist/Start Key
- Press Button On Dash - Proximity Key
- Other - Not sure
What type of service do you need for vehicle?*
- All Keys Lost - Key Origination Service
- Need Remote (Provided/Programmed)
- Key (Provided/Programmed)
- Other
Please Explain Your Service Needs Below:*
Would you like to add a fourth lot vehicle?*
- Yes
- No

Fourth Lot Vehicle
Vehicle Year*
Vehicle Make*
Vehicle Model*
Stock #
VIN # (Last Six)*
How do you start this vehicle?*
- Insert Key - Twist/Start Key
- Press Button On Dash - Proximity Key
- Other - Not sure
What type of service do you need for vehicle?*
- All Keys Lost - Key Origination Service
- Need Remote (Provided/Programmed)
- Key (Provided/Programmed)
- Other
Please Explain Your Service Needs Below:*
Would you like to add a fifth lot vehicle?*
- Yes
- No

Fifth Lot Vehicle
Vehicle Year*
Vehicle Make*
Vehicle Model*
Stock #
VIN # (Last Six)*
How do you start this vehicle?*
- Insert Key - Twist/Start Key
- Press Button On Dash - Proximity Key
- Other - Not sure
What type of service do you need for vehicle?*
- All Keys Lost - Key Origination Service
- Need Remote (Provided/Programmed)
- Key (Provided/Programmed)
- Other
Please Explain Your Service Needs Below:*

Date/Time Notice
At this current time appointment dates/times are unavailable. Upon submitting this form request a team member will get back to you very shortly in regards to an appointment date/time.

A team member will be reaching out to you via phone to confirm appointment details for your lot vehicles.
Do you have any purchase order(s)?*
- Yes
- No
Upload Purchase Orders Here:
Drop files here or
Accepted file types: jpg, gif, png, pdf, Max. file size: 10 MB, Max. files: 4.
Terms Of Agreement*
Requestee agrees that they have permission to request service & 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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Your Dealer Info