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REQUEST FOR REVIEW
Please insure this Request for Review is filled out completely so that it can be investigated
and processed without delay.
SERVICE FACILITY INFORMATION
Service Facility Name:
Service Facility Address:
City: State: Zip Code
Telephone Number ( ) Fax Number: ( )
OPERATION NUMBER
CURRENT PUBLISHED
TIME SUGGESTED TIME
VEHICLE INFORMATION:
Model Year Model Line SERIAL#
Mileage _____________________ Engine _______________________
TECHNICIAN INFORMATION:
Technician’s Name
Are you certified in this area of repair? Yes No
How many times have you performed this repair? Once Twice How many?
Is the IMPCO Service Manual Supplement accurate? Yes No Describe the inaccuracy:
(Please include any additional inaccuracies and/or suggestions on a separate sheet. We
welcome your input.)
Have you attended an IMPCO Technical Training Class for this type of work? Yes No
SERVICE MANAGER SIGNATURE: (required)
Date: (required) _____________________
A detailed, step by step labor description is required on the back of this form before a labor
time study will be considered for review.
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