Date:

Name
Phone:

Email(please print clearly):

Vehicle/Vin:

Symptom/Problem/ Issue:

LOW/ NO CONTACT OPTION

Would you like an Invoice and Receipts sent to your Email and/or Phone? Yes
(When called for pick up, Vehicle will be by the entrance door with Keys on the dashboard. Payment
can also be made over the phone. Option: Please check if you would like your card saved to file.)YesNo

• Work Authorization: I hereby authorize this repair shop to make necessary repairs in accordance with its written estimate. The
  estimate of repairs includes parts, labor, and diagnosis. Parts prices quoted are current, but are subject to change upon notice
  by manufacturer. If upon further inspection additional parts and/or repairs are needed, I will be contacted for authorization. I
  hereby authorize employees of the repair shop to operate my vehicle for the purpose of testing, inspection or delivery. Taxes
  and Service charges will be included. I understand that it is my responsibility to remove personal belongings from my vehicle
  prior to repairs, and I will not hold the repair shop or its employees responsible for loss or damage to the vehicle or articles of
  personal property left in the vehicle, regardless of value, in case of fire, theft, accident or another cause. If any Guest chooses
  to furnish his own parts warranties will be invalid and additional surcharges may apply.

• Payment Authorization: I understand that I am responsible for any payment, other labor, parts and material costs necessary to
  repair my vehicle. Unless other arrangements are made, the total amount of the repair charges must be paid in full prior the
  vehicle will be released or for delivery. Car must be picked up within 3 business days upon completion of repair. If the vehicle
  has not been picked up within the specified time otherwise a $50.00 storage fee will be applied in addition to $25.00 per day
  that the vehicle is not picked up. Any repairs that are greater than$500.00 must remit 50% of payment prior to leaving the
  vehicle on premises and prior to repairs being commenced. ALL Balances must be paid in full prior to starting any new
  services. To secure payment in the amount of repairs hereto, an express mechanic’s lien is acknowledged, and I further agree
  to pay reasonable attorney’s fees and court costs in the event that legal action is necessary to enforce this contract.

Acceptance.
Signature:
Date:

Thank You!- Eric J Automotive

WE THANK YOU FOR YOUR BUSINESS AT ERIC J AUTOMOTIVE. NEW PART; 12,000 MILES OR WARRANTY. USED PART NO
WARRANTY.