Pep King

Please take a moment to complete this form.This will enable us to make a speedy and accurate response to your query.Thank you.

	Vehicle Information:
Year
Make
Model

	Customer Information
Plant
Shift
Please indicate:	Salary Active Salary Retired
	Hourly Active Hourly Retired
Name
Social Security
Address
City
State	Zip
Home Phone
Work Phone
Fax	Email

Miscellaneous Comments/Questions:

You may print and fax this form to (330) 726-2240 if you chose.