<div class="spc-booking">
    <div class="container-section">
        <div class="row">
            <div class="column col-lg-8 col-md-8 col-sm-12 col-xs-12 form pull-sm-left">
                                <img src="/wp-content/uploads/2019/06/Speedy-Care-Logo.jpg" alt="Speedy Care" style="max-width: 573px; width: 100%;">
                <p>If you wish to book an appointment at Speedy Care, please fill in the form below.</p>
                <p>(<span class="denote">*</span> indicates required information)</p>
                <form action="/wp-json/wp/v2/pages/2958" method="post" class="" novalidate="novalidate">
                    <div class="form-group"><label for="full_name">Full Name <span class="denote">*</span></label><br>
                        <input type="text" name="full_name" id="full_name" value="" size="50" maxlength="50" placeholder="Enter your name" required>
                        <p><span class="denote"></span></p>                    </div>
                    <div class="row">
                        <div class="col-sm-6">
                            <div class="form-group"><label for="phone">Contact Number <span class="denote">*</span></label><br>
                                <input type="text" name="phone" id="phone" value="" size="50" maxlength="10" placeholder="Enter a valid contact number" required>
                                <p><span class="denote"></span></p>                            </div>
                        </div>
                        <div class="col-sm-6">
                            <div class="form-group"><label for="email">Email <span class="denote">*</span></label><br>
                                <input type="text" name="email" id="email" value="" size="50" maxlength="50" placeholder="Enter a valid email address" required>
                                <p><span class="denote"></span></p>                            </div>
                        </div>
                    </div>
                    <div class="form-group">
                        <label for="outlet_id">Select an Outlet <span class="denote">*</span></label><br>
                        <select name="outlet_id" id="outlet_id" required>
                            <option value="">Please Select</option>
                            <option value="1" >Speedy Care Balestier (462 Balestier Road, Singapore 329837)</option><option value="5" >Speedy Care Jalan Leban (1 Jalan Leban, Singapore 577546)</option><option value="7" >Speedy Care Pasir Panjang (158 Pasir Panjang Road (S) 118555)</option><option value="9" >Speedy Care Upper East Coast (157 Upper East Coast Road, Singapore 455253)</option><option value="10" >Speedy Care Yishun (599 Yishun Ring Road, Singapore 768683)</option><option value="13" >Speedy Care Toa Payoh (180 Toa Payoh Lor 6, Singapore 319381)</option><option value="14" >Speedy Care Jalan Bukit Merah (3800 Jalan Bt Merah, Singapore 159464)</option>                        </select>
                        <p><span class="denote"></span></p>                    </div>
                    <div class="row">
                        <div class="col-sm-6">
                            <div class="row">
                                <div class="col-sm-12">
                                    <div class="form-group"><label for="appt_date">Date <span class="denote">*</span></label><br>
                                        <input type="text" id="appt_date" name="appt_date" value="" placeholder="Please select an outlet" maxlength="10" required autocomplete="off" onkeydown="return false" disabled>
                                        <p><span class="denote"></span></p>                                    </div>
                                </div>              
                            </div>
                        </div>
                        <div class="col-sm-6">
                            <div class="row">
                                <div class="col-sm-12">
                                    <div class="form-group"><label for="time_slot">Time slot <span class="denote">*</span></label><br>
                                        <select name="time_slot" id="time_slot" required disabled data-input="">
                                            <option value="" >Please select an outlet and date</option>
                                        </select>
                                        <p><span class="denote"></span></p>                                    </div>
                                </div>
                            </div>
                        </div>
                    </div>
                    <div class="form-group"><label for="vehicle_model">Vehicle Model <span class="denote">*</span></label><br>
                        <input type="text" name="vehicle_model" id="vehicle_model" value="" size="50" maxlength="50" placeholder="Enter vehicle model" required>
                        <p><span class="denote"></span></p>                    </div>
                    <div class="row">
                        <div class="col-sm-7">
                            <div class="row">
                                <div class="col-sm-12">
                                    <div class="form-group">
                                        <label for="service_required">Choose Service(s) Required <span class="denote">*</span></label><br>
                                        <select name="service_required[]" id="service_required" multiple required>
                                          <option value="Lube/Oil Change" >Lube/Oil Change</option>
                                            <option value="Tyres and Rim Services" >Tyres and Rim Services</option>
                                            <option value="Other Specialized Services & Repairs" >Other Specialized Services & Repairs</option>
                                            <option value="General Consultation" >General Consultation</option>
                                        </select>
                                        <p><span class="denote"></span></p>                                        <p>Hold down the Ctrl (windows) / Command (Mac) button to select multiple options.</p>
                                    </div>
                                </div>
                            </div>
                        </div>
                    </div>
                    <div class="row">
                        <div class="col-sm-12" id="add-types" style="display:none;">
                                                        <div class="form-group">
                                <label for="lube_oil_change">Type of Package for Lube/Oil Change <span class="denote">*</span></label><br>
                                <select name="lube_oil_change" id="lube_oil_change">
                                    <option value="">Please select</option>
                                    <option value="Hybrid Protection Package @ $158 (SYNACE Hybrid SAE 0W-20)" >Hybrid Protection Package @ $158 (SYNACE Hybrid SAE 0W-20)</option><option value="Emission System Care Package @ $120 (SYNACE Ecostar SAE 5W-30)" >Emission System Care Package @ $120 (SYNACE Ecostar SAE 5W-30)</option><option value="High Performance Package @ $118 (SYNACE Racing SAE 5W-50)" >High Performance Package @ $118 (SYNACE Racing SAE 5W-50)</option><option value="All-Rounded Protection Package @ $115 (SYNACE Supreme SAE 5W-40)" >All-Rounded Protection Package @ $115 (SYNACE Supreme SAE 5W-40)</option>                                </select>
                                <p><span class="denote"></span></p>                            </div>
                        </div>
                    </div>
                    <p><img class="img-responsive alignnone" src="/wp-content/uploads/2026/06/SpeedyCare-Packages-Poster-2026-scaled.png" alt="SPC Services & Products" width="100%" style="max-width: 1200px;" /></p>
                    <p style="margin-bottom: 15px;">click <a href="/wp-content/uploads/2026/06/SpeedyCare-Packages-Poster-2026-scaled.png" alt="SPC Services & Products" target="_blank" rel="noopener noreferrer">here</a> to view full image.</p>
                    <div class="form-group"><label for="note">Note</label><br>
                        <textarea name="note" id="note" cols="40" rows="3" placeholder="Enter your message" maxlength="500"></textarea>
                        <p><span class="denote"></span></p>                    </div>
                    <div class="form-group">
                        <div class="checkbox">
                            <p><span class="denote"></span></p>                            <label class="checkbox-inline"><input type="checkbox" name="consent" value="1" required ><span class="denote">*</span></label>
                                <span style="font-size:18px;">I agree that any and all personal data submitted by me may be collected, processed, used and disclosed by SPC to :</span>
                                <ol type="i" style="font-size:18px;">
                                    <li>facilitate, process, administer and manage my appointment with Speedy Care Automotive Service Centre (hereinafter referred to as “Speedy Care”) submitted by me under the Speedy Care Appointment Booking Form;</li>
                                    <li>Speedy Care, will be used to contact or communicate with me via phone, text message or email regarding my appointment with them or any enquiries I may have; and</li>
                                    <li>that SPC may collect and store information provided by me (including but not limited to my IP address, operating system and browser type for system administration when I visit <a href="www.spc.com.sg" target="_blank">www.spc.com.sg</a> and/or use its online services, however SPC does not link the information and data automatically collected in the above manner to any personally identifiable information. If SPC does so, notice will be given.</li>
                                </ol>
                            <p><span class="denote"></span></p>                            <label class="checkbox-inline"><input type="checkbox" name="acknowledged" value="1" required ><span class="denote">*</span></label>
                                <span style="font-size:18px;">I acknowledge SPC makes no representation or warranty as to the services of the Speedy Care. Any and all disputes concerning the services rendered by Speedy Care to me shall be settled between us directly and SPC shall not in any way be involved or be brought in as a party to such disputes.</span>
                            <p style="margin-top:15px;font-size:18px;font-style:normal;">If you, at any time, have any queries in relation as to how we may manage, protect and/or process your personal data, please contact us : 1800 477 1800 or at <a href="mailto:spc_cust_svc@spc.com.sg">spc_cust_svc@spc.com.sg</a>.</p>
                        </div>
                    </div>
                    <div class="form-group">
                        <div id="html_element"></div>
                        <p><span class="denote"></span></p>                    </div>
                    <div class="form-group" style="display:inline-block; margin-bottom:3rem; width: 25rem;">
                        <input type="submit" value="Book Now" name="create_booking_appt" id="create_booking_appt" class="send-message"><div class="loader" style="display:none;"></div>
                    </div>
                    <div class="response-output display-none"></div>
                </form>
            </div>
        </div>
    </div>
</div>
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