Repair History Form

Use this form for each repair performed on your VW.  For multiple repairs, reset the form and submit as many times as necessary to enter all repairs.  (TAB between fields.)

  1. Enter the part of your email address.  This is required to link with your vehicle data that you should have already entered.

     @    * required fields

  2. If you registered more than one VW, you must select the year and model.  (Otherwise skip these fields.)

    Year:   Model:    Number you assigned: (Use only if more than one VW of same year and model.)

  3. Enter the date of repair and miles on odometer when repaired :

    date: -- mm/dd/yy        odometer miles 

  4. Select the category of repair :

    *required to select one

  5. What was the approximate cost of the repair?      $ (nearest dollar)

  6. Who performed the repair?       *required to select one

  7. Provide a brief description of repair and any pertinent details.  (Use a feedback form to supply more details if necessary.)

  8. Yes  Do you have more repairs to report?
    No   *Required to click "Yes" or "No".

Copyright 2002, HP products.   All rights reserved.
Revised: 03/25/12