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DIRECTIONS
1)  Fill in contact information. Please Print
2)  Write your service request on the envelope
3)  Place keys in this envelope & drop in the slot in front bay door
4)  We will contact you by 9:00am to confirm receipt

Name:____________________________Email:____________________________
Address: ___________________________________________________________
Phone - Cell:_______________________ Other:___________________________
Vehicle Year:_____ Make:_________ Model:_________ Color________________

MAINTENANCE SERVICE REQUESTED

__ Oil & Filter Change   __Standard     __High Mileage   __Full Synthetic   
__ Engine Tune Up
__ Auto Trans Fluid Flush
__ Air Filter Change
__ Brake Fluid Flush
__ Cabin Filter Change
__ Coolant/Radiator Flush
__ Differential Fluid Change
__ Fuel Injection System Cleaning
__ Fuel Filter Change
__ Manual Trans Fluid Change
__ Tire Rotation
__ Trip Inspection
__ Computerized Wheel Balance
__ Wiper Blades
__ 30/60/90 Factory Maintenance

REPAIR NEEDS
__ Dash Warning light is on                         __ Brake Inspection
__ Will Not Start                                         __ Fluid Leak
__ Runs Poorly                                           __ Noise / Vibration

Comments:__________________________________________________________
____________________________________________________________________
____________________________________________________________________
I hereby authorize up to $_________ repair work to be done along with the necessary parts and supplies. Employees may operate this vehicle on streets & hwys. for the purpose of testing or delivery. The Auto Mechanic Specialist or the employees are not responsible for any damage of or theft of vehicle or any contents. For non-payment of repairs and parts, an express mechanic's lien is hereby acknowledged on above vehicle to secure the amounts of repairs thereto.

Signature_________________________________ Date__________________________

We will call you when your vehicle is ready for pick-up.  Please schedule a pick-up before 6:30 pm. Mon - Sat.  A courtesy ride will be available upon request.

Thank you for choosing The Auto Mechanic Specialist.  Your business is greatly appreciated.

 
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