* Boxes with a red star must be completed please.

Your Appointment
Location *	Hamilton St. Catharines New Hamburg
Preferred appointment date *
Preferred appointment time *	Please Choose Hamilton St. Catharines/Niagara New Hamburg
Alternate time (if 1st choice is not available)
Preferred Service Advisor	Please Choose Shirley Tim Paul Eric Bill Karina Ross Allan Gary Sue
Do you have a John Bear Rewards card? *	Yes No
	John Bear Rewards program information