Road Test Request

Fill this form and we will contact you as soon as possible.

*Fields marked with an asterisk are mandatory

First name:

Last name:

Address:

City:

Province:

Postal code:

(format : A9A 9A9)

Telephone:

- ext:

E-mail:

Desired vehicle:

Road test date:
(YYYY/MM/DD)

/ / [Calendar]

Questions or comments:

Type the characters you see in the picture:

YES! I want to receive information on future contests, surveys, special promotions and new content from "Pickering Honda".

Pickering Honda - 575 Kingston Road, Pickering, ON L1V 3N7 - Tel. : 1 866 953-9049 - Fax : 905 831-3381