FOR OUR EARLY BIRD OR LATE EVENING SERVICE CUSTOMERS
1. WRITE YOUR ORDER ON THIS FORM
2. LEAVE YOUR VEHICLE ON THE SIDE OF THE BUILDING AND LOCKED.
3. PLACE FORM - KEYS - SERVICE COUPONS IN THE ENVELOPE
(Envelopes are inside the early bird box)
4. DROP ENVELOPE IN THE SLOT
1. WRITE YOUR ORDER ON THIS FORM
2. LEAVE YOUR VEHICLE ON THE SIDE OF THE BUILDING AND LOCKED.
3. PLACE FORM - KEYS - SERVICE COUPONS IN THE ENVELOPE
(Envelopes are inside the early bird box)
4. DROP ENVELOPE IN THE SLOT
Name: ________________________________________________ Lic. No. ________________________
Address: __________________________________________________________________________
City: ___________________________________________________ Zip: _____________________
Home Phone: _______________________________ Work/Cell Phone: ____________________________________
Email: ___________________________________________________ Mileage: _______________________________
Year: ___________________ Color: _________________ Make & Model: ________________________________
Where should we contact you? ____________________________________ By Phone or Email? ________________
__________ Change Oil, Filter & Lube __________ Replace Muffler __________ Change Transmission Oil
__________ Check Engine Light Illuminated __________ Repair Lights __________ Fluid Leak Under Vehicle
__________ Reline Brakes __________ Adjust Brakes ___________ Replace/Adjust Clutch
__________ Runs Bad or Stalls __________ Check Belts & Hoses __________ Replace Battery
Other Work (Please provide as much detail as possible) __________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
I hereby authorize the repair work herein set forth to be done by you, together with the furnishing by you of the necessary parts and other material for such repair, and agree: that you are not responsible for any delays caused by unavailability or delayed availability of parts or material for any reason; that you neither assume nor authorize any other person to assume for you any liability in connection with such repair; that you shall not be responsible for loss of or damage to the above vehicle, or articles left therein, in case of fire, theft or other cause beyond your control; that an express mechanic's lien is hereby acknowledged on the above vehicle to secure the amount of repairs thereto; that your employees may operate the above vehicle on streets, highways or elsewhere for the purpose of testing and/or inspecting such vehicle.
PLEASE SIGN HERE: ___________________________________________________________________
Address: __________________________________________________________________________
City: ___________________________________________________ Zip: _____________________
Home Phone: _______________________________ Work/Cell Phone: ____________________________________
Email: ___________________________________________________ Mileage: _______________________________
Year: ___________________ Color: _________________ Make & Model: ________________________________
Where should we contact you? ____________________________________ By Phone or Email? ________________
USE THIS HANDY CHECK LIST
__________ Mileage Inspection __________ Mile Diagnosis __________ Alignment __________ Tune Engine__________ Change Oil, Filter & Lube __________ Replace Muffler __________ Change Transmission Oil
__________ Check Engine Light Illuminated __________ Repair Lights __________ Fluid Leak Under Vehicle
__________ Reline Brakes __________ Adjust Brakes ___________ Replace/Adjust Clutch
__________ Runs Bad or Stalls __________ Check Belts & Hoses __________ Replace Battery
Other Work (Please provide as much detail as possible) __________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
I hereby authorize the repair work herein set forth to be done by you, together with the furnishing by you of the necessary parts and other material for such repair, and agree: that you are not responsible for any delays caused by unavailability or delayed availability of parts or material for any reason; that you neither assume nor authorize any other person to assume for you any liability in connection with such repair; that you shall not be responsible for loss of or damage to the above vehicle, or articles left therein, in case of fire, theft or other cause beyond your control; that an express mechanic's lien is hereby acknowledged on the above vehicle to secure the amount of repairs thereto; that your employees may operate the above vehicle on streets, highways or elsewhere for the purpose of testing and/or inspecting such vehicle.
PLEASE SIGN HERE: ___________________________________________________________________
