Padgetts Tire & Auto Shop Drop Off Form
12801 Brandywine Road - Brandywine, Maryland 20613 - Phone: 301-372-6710

Instructions:

  1. Please print this form and fill in your service instructions.
  2. Sign at bottom of form.
  3. Lock your vehicle.
Name:
______________________________________________________
Address: ______________________________________________________
City: __________________________
Business Phone: __________________________
Home Phone: __________________________
Cell phone: __________________________
Email: ______________________________________________________
Year: ______________ Make:______________ Model: ______________
License No.: ______________ Mileage:_____________Color:_______________
Check or Repair the following: 
Lubrication Service 
Oil & Filter
Air Cleaner
Transmission Service
Oil Leaks
Engine Tune-Up
State Inspection
Service Brakes
Align Front End
Balance Wheels
Rotate Tires
Service Air Conditioning
Comments:
Do You Want Your Old Parts? Yes   No
NOT RESPONSIBLE FOR ANY VALUABLES 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 express 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.

Signature X __________________________

NOTICE: This form must be signed before we can begin work on your vehicle.

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