(Please print off this page and leave it, filled out and signed, in the mail box)

Customer Information:
Name :___________________________________________ Phone:_______________________

Address__________________________________________

City :_____________________ State:______________ Zip:______________________________

 
Vehicle Information:
Year:_____ Make:__________________ Model:______________ License Plate:______________

Color:_________________ Body Style/Type:__________________________________________


Work Requested:
(Please provide as much information as possible)










We will call you with an estimate before any work is done.


I hereby authorize the above services to be preformed along with the necessary material and hereby grant Aaffordable Auto Service's permission to operate the vehicle for the purpose of testing and or inspection at my own risk. I affirm and attest that this vehicle is lawfully insured in the state in which it is registered. An express mechanics lien is here by acknowledged on the above vehicle to secure the amount of services owed. There will be a $15.00 per day storage fee for vehicles left after 5 days of completion of service. Aaffordable Auto Service is not responsible for lost or damaged cars or articles left in cars in case of fire, theft, or any other cause beyond our control.


Signature:_________________________________Date:________________