CLIENT NAME*

CLIENT PHONE*

DATE &

TIME

Address*

City*

State*

Zip code*

Email*

TAG NO*

Vehicle year*

Make*

Model*

VEHICLE ISSUES / REQUESTED WORK

/ DESCRIPTION*

How did you hear

about us

Will you need a Rental Car (YES/NO)

YES

Free QUICK complementary auto check (YES/NO)

YES

Will you need a car wash

or detailing

TECHNICIAN

NOTES

Customers are responsible for removing important and personal items from their vehicle as repair work may sometimes be performed by multiple technicians and or repair shops. Management is not responsible for loss of property or damage to vehicles. Customers are also responsible for securing their means of payment including communicating with insurance company if necessary or completing financing requirements & procedures. By signing, you also agree that we can repossess your vehicle in event of defaulting payment or nonpayment of repair work (customer will pay for towing and storage in event of repossession of vehicle for balance due). Mechanic lien may apply where necessary. Your vehicle meets state reg requirements & authorize us to operate it on streets, highways or elsewhere for testing, inspection, completion of driving cycle, and reliability.

Signature of

CLIENT*