Vehicle Information Form

This data will be used along with repair information that you provide on another form.

  1. If you are a subscriber to EuroVan Update or New Beetle Update, enter your ID number found on first line of mailing label. (If not known, enter the first four characters of last name followed by 5-digit zip code.) Non-subscribers, please leave blank.

       Use TAB to navigate fields!

  2. This question will form the basis of unique ID that will be used to link your vehicle data with your repair data. In addition, it will provide your email address so results of the survey can be forwarded to you when available.  (This will be stored as two fields to prevent automated programs from finding your email address.)

    @ *Required fields

  3. Select the year and model (Jetta, EuroVan, etc.)

                       

  4. If you have more than one VW of the same model and year, enter a number (e.g. 1, 2, ...) and use it each time you enter repair data for this VW.

    (infrequently used field)

  5. Enter your engine type (2.0 L gas, 1.8 L turbo, TDI,...):


  6. Choose the transmission type (auto or manual):


  7. Enter the number of miles on your VW as of the date indicated.

    odometer reading in mi. on date: -- mm/dd/yy

  8. How many miles do you normally drive this car in a 12 month period or how many miles was it driven over the last 12 months? (Approximate):


  9. Would you like to receive the results of this survey by email when it becomes available?

    Yes
    No

  10. Did you have any repairs performed on your VW in the past 12 months (other than oil changes)?

    Yes  (If you check YES, be sure to fill out a repair form for each repair that was done.)
    No   *Required to click "Yes" or "No".

  11. This completes the vehicle registration process.  If you have any additional information to add, space is provided here. (If you need a reply, email me at the address provided on the home page or use the feedback form.


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