Online Maintenance Request
First Name
Last Name
Name of Assigned Driver (If different than name)
Relation to Assigned Driver
Company
Business Email
Service Card Number
Vehicle Vin
Vehicle Year
Vehicle Make
Vehicle Model
Current Mileage/Kilometres
Business Phone
Yes
No
Not sure
Is your vehicle due for an oil change?
What problems are you experiencing with your vehicle?
For emergency roadside assistance, please contact Element Maintenance that is shown on the back of your service card or call 800-638-7900.
Do you have a repair facility that you prefer to use?
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