After Hours Car Drop Form

1 – Please write your service instructions on this envelope

2 – Lock your car, attach keys to this form (insert both in a sealed envelope)

3 – Sign at bottom and drop in our mail slot

Name ____________________________________________________

Address ______________________________ City ________________

Zip Code ________________ Mileage __________________________

Bus. Phone __________________ Home Phone ___________________

Year ________ Make _________________ Model _________________

License Number _________________________ Color ______________

Check/repair the following:

Lubrication Service	Clutch
Oil & Filter	Brake
Air Cleaner	Alignment
Transmission Oil	Wheel Bearings
Differential Oil	Balance Wheels
Oil Leaks	Rotate Tires
Engine Tune-up	Steering & Shocks
Muffler	Lights
Exhaust System	Air Conditioning
Emission System	Flush Radiator
State Inspection	Body Damage
	Undercoat

Comments:

Do you want old parts (circle one)? Yes No

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 expressed mechanic’s lien is acknowledged on the above vehicle to secure the amount of 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.

Signed X ___________________________________________________