| Name: |
______________________________ |
| Street Address: |
______________________________ |
| City: |
______________________ State:
_____ ZIP: _________-_______ |
| Home Phone: |
( __ ) ______-________ |
|
Vehicle
Information |
| Year: |
________ |
| Make: |
____________ |
| Model: |
____________ |
| Color: |
____________ |
| License: |
____________ |
|
|
| Work Phone: |
( __ ) ______-________ |
| Cell Phone: |
( __ ) ______-________ |
| Pager: |
( __ ) ______-________ |
|
PLEASE
WRITE YOUR INSTRUCTIONS BELOW |
|
|
THE FOLLOWING MUST BE COMPLETED AND SIGNED |
You have the
right to an estimate if the expected cost of repairs or service exceeds $25.00. Please initial your choice, and sign at the bottom. |
|
. Written estimate
|
|
. Oral estimate
|
|
|
. I do not request an
estimate |
|
If you choose
"written estimate", you will be required to sign a repair authorization prior to
us beginning. |
| . Do you want your old
parts? |
|
. Yes
|
|
|
. No |
|
I
hereby authorize the service, repair or estimate as requested above. Employees
or agents of Automotive Excellence, Inc. may operate the above vehicle for purposes of
testing, inspection or delivery at my risk. An express mechanics lien is
acknowledged on the above vehicle to secure the amount of repairs thereto. You will
not be held responsible for loss or damage to vehicle or articles left in vehicle in case
of fire, theft, accident or any other causes beyond your control. |
|
Signature:
_____________________________ Date:
__________ |
|
