Vehicle Intake and Headlight Inspection Form
Vehicle Intake and Headlight Inspection Form
Vehicle Owner Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Vehicle Make
*
Vehicle Model
*
Vehicle Year
*
Odometer Reading
*
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Headlight Inspection Checklist
*
Rows
Status
Left low beam
1
Right low beam
2
Left high beam
3
Right high beam
4
Headlight lenses and housings
5
Headlight alignment
6
Inspection Findings or Recommended Work
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