Owners name _______________________    Year ____  Make _________________
Address ____________________________    Model ______________  Color ______
City___________ State____ Zip ________    Lic. Plate #______________________
Phone Number _______________________    Alarm: Y or N   Brake trouble:  Y or N

Vehicle Complaint or requested service:
(If your car has low oil or other fluid, or if your car should not be started, please list reasons.)
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Sing Here: X_______________________________  Date: ______________________

Warranty on parts and labor is two years or 24,000 miles whichever comes first.   I hereby authorize the above repair work to be done along with the necessary material and hereby authorize voice and electronic (email) revisions to invoice for additional parts and repairs as necessary.   All Parts removed will be discarded unless instructed otherwise:  Save all Parts____.   I WILL NOT HOLD THIS FACILITY  RESPONSIBLE FOR LOSS OR DAMAGE TO CAR OR ARTICLES LEFT IN CAR IN CASE OF FIRE, THEFT OR ANY OTHER CAUSE.   I authorize an express mechanic's lien until invoice is paid in full.  I agree to pay reasonable storage on this vehicle if left more than five working days after customer notification of completed repairs.

Please be sure to drop your alarm remote and keys into the door slot with this completed form.  Please include only the cars keys.  Please be sure keys and form fall through the door into the bin.

Thank you and have a great day!