Company Name
Company Address
Company City, ST 99999
Pho.ne_.one_ Pho.ne_.two_
Customer / Vehicle Information
Name: Year, Make, Model
Address:
Plate #:
VIN:
Phone: Mileage
Date Color
   
ALL PARTS NEW UNLESS SPECIFIED
U-USED        R-REBUILT        W-WARRANTY 		Retain Parts
U/R/W Qty Part # Part Name Each Amount

Service Requests
Services Labor
Comments/Mechanic's Recommendations:

I HEREBY AUTHORIZE THE ABOVE REPAIR WORK TO BE DONE ALONG WITH THE NECESSARY MATERIAL AND HEREBY GRANT YOU AND OR YOUR EMPLOYEES PERMISSION TO OPERATE THE CAR, TRUCK OR VEHICLE HEREIN DESCRIBED ON STREETS HIGHWAYS OR ELSEWHERE FOR THE PURPOSE OF TESTING AND OR INSPECTION.
AN EXPRESS MECHANICS LIEN IS HEREBY ACKNOWLEDGED ON ABOVE CAR, TRUCK OR VEHICLE TO SECURE THE AMOUT OF REPAIRS THERETO.
Estimated Cost:
Customer Authorization:                                                                                
Daily storage fee after repair work has been completed and customer has been notified. No charges shall accrue or be due and payable for period of 3 working days from date of notification.
Parts:
Labor:
Misc:
Storage:
Tax:
Total: