New Customers
(all information is required)
First & last
name:
First Name
Last Name
Your mailing address:
Your city, state and
zip code
City
State
Zip
Best number to
contact you at any time
Area Code
Number
Extension
Your e-mail address:
(optional)
Please enter the address were you will like
us to perform your service
Address
City
Zip
Same as
above
At what time will you like your service
performed if available
First Choice
5:00 am to 7:00 am
7:00 am to 9:00 am
9:00 am to 11:00 am
11:00 am to 1:00 pm
1:00 pm to 3:00 pm
3:00 pm to 5:00 pm
Second Choice
5:00 am to 7:00 am
7:00 am to 9:00 am
9:00 am to 11:00 am
11:00 am to 1:00 pm
1:00 pm to 3:00 pm
3:00 pm to 5:00 pm
What day of the week will you like your
service performed if available
First Choice
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Second Choice
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Your vehicles year, make and model
year
make
model
Vehicle engine size
for oil change & maintenance
purposes
Unknown
is your vehicle
Gas
Diesel
is your vehicle
Car/Truck
RV
HD Equipment
Vehicle color
for wash & detail purposes
color
ENTER SERVICES
Please enter a description of the
service you are interested in and
submit. One of our Certified Technicians
will contact you as soon as possible to
answer any questions you may have.
Please be patient as some of our
technicians are out of a coverage area
at times and won't be able to contact
you promptly.
Appointments Are Determined by availability
and weather permitting. Rapid Mobile
Enterprises will due its best to fit you in
our schedule for the time you have
requested.
The information you have provided on the form
above is strictly confidential. Your name,
company name, e-mail address, or any of the information
you provide is NEVER sold, rented, loaned,
or made available to anyone outside our
organization.
#1 Repeat Customers & Fleet Accounts
First & last name:
First Name
Last Name
Company name
required for
fleet & corporate accounts
Request a time and day
for service
(if your company
has a set schedule choose option 3.)
Time - First Choice
2) No Preference
3) As Scheduled Per Our Contract
4) 5-6 am
5) 6-7 am
6) 7-8 am
7) 8-9 am
8) 9-10 am
9) 10-11 am
10) 11-12 noon
11) 12-1 pm
12) 1-2 pm
13) 2-3 pm
14) 3-4 pm
Time - Second Choice
2) No Preference
3) As Scheduled Per Our Contract
4) 5-6 am
5) 6-7 am
6) 7-8 am
7) 8-9 am
8) 9-10 am
9) 10-11 am
10) 11-12 noon
11) 12-1 pm
12) 1-2 pm
13) 2-3 pm
14) 3-4 pm
Day - First Choice
2) No Preference
3) As Scheduled Per Our Contract
4) Monday
5) Tuesday
6) Wednesday
7) Thursday
8) Friday
9) Saturday
Day - Second Choice
2) No Preference
3) As Scheduled Per Our Contract
4) Monday
5) Tuesday
6) Wednesday
7) Thursday
8) Friday
9) Saturday
Enter your vehicle year,
make, model and license plate number.
Year
Make
Model
License plate number
Enter the number of vehicles being serviced
and Unit or License Plate Numbers
Required for
fleet accounts
Please
specify the services we are performing
below under ENTER SERVICES
Best number to contact you at
any time
Area Code
Number
Extension
Your e-mail address:
(optional
ENTER SERVICES
Please enter a description of the
service you are interested in and
submit. One of our Certified Technicians
will contact you as soon as possible to
answer any questions you may have.
Please be patient as some of our
technicians are out of a coverage area
at times and won't be able to contact
you promptly.
Appointments Are Determined by availability
and weather permitting. Rapid Mobile
Enterprises will due its best to fit you in
our schedule for the time you have
requested.
The information you have provided on the form
above is strictly confidential. Your name,
company name, e-mail address, or any of the information
you provide is NEVER sold, rented, loaned,
or made available to anyone outside our
organization.