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Check all that apply.

1. The A/C system cools OK?  Yes  No  Sometimes
2. Does the fan/blower work?  Yes  No
3. Does the fan/blower work at all speeds?  Yes  No
4. Is the fan/blower noisy?  Yes  No
5. Do all the dash controls work OK?  Yes  No
6. Do the vent, heater and defroster work OK?  Yes  No
7. Is A/C noisy when turned on?  Yes  No
8. Does car stall or idle funny when A/C is on?  Yes  No
9. Does your car overheat?  Yes  No
10. Has the A/C filter/dryer ever been replaced?  Yes  No
11. Does A/C or heater smell?  Yes  No
12. When was the A/C last serviced?  Within 3 months  Within 6 months  Within 1 year  Never  Don't know
13. Other problems:
    
14. Comments: