Request Brochure Form

Sales Dept. Phone#: (506) 458-8955

If you would like to request a 2010 Brochure on our new models
at Fairview Chrysler Jeep Dodge Ltd.,
please fill out and submit this form:

Please fill out the information required to contact you :

Name:	REQUIRED
E-Mail:	REQUIRED
Phone:
Address:
City:
Province:	Postal Code:

Please fill out both a Make and Model :

Year:
Make:
Model:
Cylinders:	4 6 8
Transmission:	Automatic Manual
Drive Train:	2 Wheel Drive 4 Wheel Drive All Wheel Drive

Please check off all that applies to your request:
Chrysler Dodge Jeep	Compact Mid-Size Large-Size	Coupes/Sedans Convertibles Minivans	SUVs Trucks Cargo Vans

Do you have a Trade In ? Yes No

Year:
Make:
Model:
Kms:

I plan to purchase within the next
Week, Month, 3 Months, or 6 Months.

Please enter any comments or questions :

Disclaimer

We and our service providers and affiliates will use the information provided by you to (i) perform services as may be directly requested by you; (ii) provide more information regarding the products and services of us, our affiliates and business partners, (iii) generate statistical and aggregated data that does not identify you personally, and (iv) disclose your information to our service providers and affiliates for the purpose of providing services to you and to provide you more information regarding their products and services. By providing your information to us, you consent to these uses. You may notify us in writing if in the future you do not consent to any of these uses of the information you provide.

Sincerely,

Karen Baglole
Fairview Chrysler

By checking this you agree to the terms of this disclaimer.

Phone: (506) 458-8955 Fax: (506) 450-8994 E-mail: sales@fairviewchrysler.ca