Night Drop Form

Comments

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Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Please try to have car ready by:

Business Phone*

Home Phone*

Year*

Make*

Model*

Car License Number*

Color*

Mileage

Check / Repair The Following:

Repairs Requested

Comments

Do You Want Your Old Parts?*

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NO

Property Disclaimer*

NOT RESPONSIBLE FOR ANY PERSONAL ITEMS LEFT IN VEHICLE. I hereby authorize the above repair work to be done along with the necessary materials. You and your employees may operate the above vehicle for purposes of testing, inspection or delivery at my risk. An express mechanic’s lien is acknowledged on the above vehicle to secure the amount of the 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 cause beyond your control.

I have read and agree to the above conditions.

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Simply Superior Service

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