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Please check the Availability page to ensure appointments are available on your requested day before you complete this form! Payment will be accepted at time of service. Visa, Mastercard, Personal Check, and Cash are all accepted. Cash customers will receive a 5% discount.

* Required fields
Name *
E-mail Address *
Address *
Make of Cart *
Battery Voltages *
Installation *	Y ($40) N (free delivery, Peachtree City only)
Month *
Date *
Preferred Appointment Time
Phone Number *
Cell Phone *
Payment Type	Visa/Mastercard Check Cash (5% discount)
Special Instructions or Requests
	I understand that Battery Doctors requires phone confirmation before installation.

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