Tom Roush Lincoln Mercury - Scheduled Maintenance Form

LINCOLN / MERCURY PASSENGER CARS
MAINTENANCE SERVICE REQUEST FORM

As a convenience for our customers, you may fill out the form below to schedule your routine maintenance, for any Lincoln or Mercury vehicle. Simply tell us the day and time you will bring the car in and we'll have your paperwork prepared.

CHECK THE RECOMMENDED SERVICE TO SCHEDULE
1999-2003 Lincoln-Mercury Vehicles

FOR VECHICLES
PRIOR TO 1999
CLICK HERE

Check The Service You Wish To Schedule:
	QCM-A (GAS)	Every 6 months/5,000 miles OR every 3 months/3,000 miles*
	QCM-AD (DIESEL)	LINCOLN-MERCURY RECOMMENDED SCHEDULED MAINTENANCE
	Change engine oil and filter (1P)		ADDITIONAL SERVICE FOR LIGHT TRUCKS, SUVs AND VANS
	Change engine oil and filter (Diesel) (2P)		Check Air Filter Minder on 7.3L Diesel (20P)
	Perform multi-point inspection (99P)		(extra charge of $41.26 if filter replacement required) (102P)
	Rotate tires (230P)
				Price	$49.84
				Price (Diesel)	$91.01

	2001-2002 Vehicles: Initial Tire Rotation should be performed at 5,000/6,000 miles. After that, Tire Rotation is
	recommended at 15,000 miles and every 15,000 miles thereafter. 1999-2000 Vehicles: Rotate tires every 3,000/5,000 miles.

	* See chart for vehicle-specific recommended service and Special Operating Conditions requirements.
	Ask about the Ford Quality Maintenance Protection Program.

QCM-B (GAS)


15,000/45,000/75,000/105,000/135,000 Miles*
QCM-BD (DIESEL)	FORD-RECOMMENDED SCHEDULED MAINTENANCE
Change engine oil and filter (1P)		ADDITIONAL SERVICE FOR LIGHT TRUCKS, SUVs AND VANS
Change engine oil and filter (Diesel) (2P)		Check Air Filter Minder on 7.3L Diesel (20P)
Inspect brake system (54P)		(extra charge of $41.26 if filter replacement required) (102P)
Inspect engine cooling system, hoses and clamps (59P)		Replace fuel filter (7.3L Diesel) (134P)
Perform multi-point inspection (99P)		Inspect steering linkage, ball joints, suspension and driveshaft (252P)
Rotate tires (230P)
			Price	$107.90
			Price (Diesel)	$213.17

* See chart for vehicle-specific recommended service and Special Operating Conditions requirements.


QCM-C (GAS)	30,000/60,000/90,000/120,000/150,000 Miles*
QCM-CD (DIESEL)	FORD-RECOMMENDED SCHEDULED MAINTENANCE
Change engine oil and filter (1P)		ADDITIONAL SERVICE FOR LIGHT TRUCKS, SUVs AND VANS
Change engine oil and filter (Diesel) (2P)		Replace engine air filter (7.3L Diesel) (102P)
Inspect brake system (54P)		Replace fuel filter (7.3L Diesel) (134P)
Inspect engine cooling system, hoses and clamps (59P)		Rotate tires (230P)
Perform multi-point inspection (99P)		Inspect steering linkage, ball joints, suspension and driveshaft (252P)
Replace fuel filter (gasoline engines) (132P)		Inspect complete exhaust system and heat shields (254P)
			Price	$155.00
			Price (Diesel)	$282.27

* See chart for vehicle-specific recommended service and Special Operating Conditions requirements.


QCM-D (GAS)	100,000 Miles*
QCM-XD (DIESEL)	FORD-RECOMMENDED SCHEDULED MAINTENANCE
Change engine oil and filter (1P)		ADDITIONAL SERVICE FOR LIGHT TRUCKS, SUVs AND VANS
Change engine oil and filter (Diesel) (2P)		Check Air Filter Minder on 7.3L Diesel (20P)
Perform multi-point inspection (99P)		(extra charge of $41.26 if filter replacement required) (102P)
Rotate tires (1999-2000 only) Additional Cost of _______ (230P)
			Price	$49.84
			Price (Diesel)	$91.01

* See chart for vehicle-specific recommended service and Special Operating Conditions requirements.

OTHER INFORMATION:

NORMAL SCHEDULE
Change your engine oil and filter every 6 months or 5,000 miles if your driving habits do not include any of the conditions shown under Special Operating Conditions.

SPECIAL OPERATING CONDITIONS
Change your engine oil and filter every 3 months or 3,000 miles if your driving habits mainly include one or more of the following:
		Towing a trailer or using a camper or car-top carrier
		Extensive idling and/or low-speed driving for long distances, as in heavy commercial use such as delivery, taxi or patrol car
		Operating in dusty conditions such as unpaved or dusty roads
		Off-road operation

Enter The Following Information About Your Vehicle:

Year:
Make:
Model:
Vehicle ID#: (if you have it available)
License Plate Number: State Issued:
Odometer Reading:	Miles
Other Comments or Service Items To Check or Complete:
The Following Information Is Needed To Submit This Form ( * is Required ):
First Name:*
Last Name:*
Address:* Apt #:
City:*
State*
Zip Code*:
E-Mail Address:* (for confirmation)
Office Phone Number:*
Home Phone Number:
Cellular Phone Number:
Other Phone Number (pager, etc.):
Best Place To Reach You:	Home Cellular	Office Other
SERVICE HOURS ARE Monday - Friday: 7:30 AM to 6:00 PM Saturday: 7:30 AM to 3:30 PM
Date you wish to bring your car for service:
Time you wish to bring your car for service:
If you would like to submit this Form by E-Mail, Click SUBMIT below:

TOM ROUSH LINCOLN MERCURY MAZDA
Is Located On
US 31 North at 169th St.
(317) 896-5561

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