12801 Brandywine Road - Brandywine, Maryland 20613 - Phone: 301-372-6710
- Please print this form and fill in your service instructions.
- Sign at bottom of form.
- Lock your vehicle.
|Year:||______________ Make:______________ Model: ______________|
|License No.:||______________ Mileage:_____________Color:_______________|
|Check or Repair the following:||
|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.