Customer

Name: _________________________________________________
Phone: _________________________________________________
Email: _________________________________________________
Address (optional): ______________________________________

Vehicle

Year / Make / Model: _____________________________________
Odometer: ______________________ Fleet Vehicle? ☐ Yes ☐ No
Fleet Vehicle Number (if applicable): _______________________

License Plate: ____________________ State: ________________
VIN (only if plate not available): __________________________

Concern / Service Requested

___________________________________________________________
___________________________________________________________
___________________________________________________________

Acknowledgments

☐ Customer acknowledges and agrees to the shop Disclaimer & Warranty and limitation of liability terms.
☐ If customer supplies parts, customer acknowledges no warranty on customer-supplied parts.
☐ If performance modifications requested, customer acknowledges Performance / Off-Road waiver (if applicable).

Abandoned & Storage Notice: Abandoned vehicles may be subject to a mechanic’s lien as allowed by law. Vehicles left more than 48 hours after completion and notification may be subject to a daily storage fee.

Signature

Customer Signature: _______________________________________ Date: _______________