Complete the form below and ensure all the information is correct in order for us to assist you in completing the service request.

Your Workshop is: Jacobs – B&R Auto
Personal Details
Name (*required)

Surname (*required)

Contact number   (*required)

Your Email Address   (*required)

Vehicle Details
Vehicle Make (Manufacturer)   (*required)

Vehicle Model    (*required)

Engine Capacity (   

Vehicle Colour   (*required)

Vehicle Registration Number   (*required)

Vehicle KM Reading

Proposed Date you are bringing the car in

We will confirm via email once accepted
What service would you like done to your vehicle?
Choose a Service typeMinor ServiceMajor ServiceMajor RepairMinor RepairOther
Additional Comments