_____ Name of Business_________________________________

_____ Address_________________________________________

_____ Major cross streets________________________________

_____ City ___________________ State__________ Zip _______

_____ Phone number (           )   __________________________

_____ FAX Number (         ) ______________________________

_____ E-mail address ___________________________________

______Website_________________________________________

_____ Owners name ____________________________________

_____ Been in business since?   __________________________

_____ Pick one  ________  General repair on American/Imports

                          ________  General repair on Import Only

                          ________  General repair on American Only

                          ________  General repair on _______________
                                            ( ie Volvo and Honda)

                          ________  Specialty shop _________________
                                          (ie Brks, Radiators, Align, Trans)

_____ How many Techs do you have?_____________________

_____ How many are ASE certified? _______________________

_____ How many are ASE Master Techs? __________________

_____ How many have an L-1 rating?  _____________________

_____ Hours of operation?_______________________________
                                                   (ie M-F 7:30 to 6 Sat 8-4)

Page two

_____ Are you a member of ASA?_________________________

_____ Are you a AAA Approved facility?____________________

_____ Are you an ASE Blue Seal shop?_____________________

_____ Any more info you want us to know?_________________

______________________________________________________

______________________________________________________

______________________________________________________

______________________________________________________

Name of person nominating shop_________________________

Phone # of person nominating shop (      )__________________

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EVERY field must be filled out, you will need the shop owner's help to accomplish this. In the event you leave out important information, we will not process your nomination.