Win Gas Card

We’re giving away $250
worth of gasoline and it could be you.

Refer a friend and you both could win!

How the online draw works: You enter the online draw below and have a change to win a $250.00 gas card. If you refer a friend below, they could win $150.00 by entering the contest and you would get $100.00 if they won! Its that easy....

• Remember - A poorly maintained vehicle can consume more fuel, create more greenhouse gases, produce more air pollution and be a hazard to you and everyone else on the road.

• A well maintained car will run better, use less fuel and produce less pollution.

• Maintaining your vehicle will help avoid nasty surprises and will keep you moving. Who wants to be mentioned in the next traffic report?

• Keeping your vehicle maintained will save you money!

For your chance to win, simply fill out the form below.

First Name:
Last Name:
Gender:	Female        Male
Phone:
Email:
Address:
Postal Code:
City:
How did you find out about this contest? -Please Select- Referral Facility Website Newsletter Flyer Other
Do you currently service your vehicle(s) at Sil’s Auto Diagnostic Centre? -Please Select- Yes, Always Yes I do Sometimes Not yet
How many vehicles are in your household? -Please Select- 1 2 3 4 5 or more
When was the last time you serviced your vehicle? -Please Select- 0-3 Months 4-8 Months 9-12 Months Over a year ago
Please check off the vehicle services below that you have over the last 6 months: New Tires    Brake Service    Oil Change Service (LOF)   Aquapel Windshield Treatment   Seasonal Maintenance Service
Your Vehicle Details:
Vehicle 1:	Make:
	Model:
	Year:
Vehicle 2:	Make:
	Model:
	Year:
Vehicle 3:	Make:
	Model:
	Year:
What proportion of your total auto repairs and services expenditures do you spend at Sil’s Auto Diagnostic Centre?  -Please Select- Less then 10% 10-30% 31-50% 51-70% 71-90% Almost All
Have you had any vehicle breakdowns this year?  -Please Select- Yes I have had a Breakdown No, I have not had a vehicle breakdown
If so, what was the cause? (ie. Dead Battery, Tire Blow Out...)
Refer this draw to a friend and you will have 2 chanes to win!
Referral First Name: Referral Last Name:  Referral Email Address:
Referral First Name: Referral Last Name:  Referral Email Address:
Do you have any additonal Comments to send to us?

Thank you for participating.  Click the ’Submit’ button to send in your entry ballot.

 

Please type in the six letters and/or numbers you see in the box below.