UMR - REPAIR AUTHORIZATION FORM

REPAIR AUTHORIZATION FORM

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Unlimited Maintenance and Repair LLC

4803 Freedom Rd. Houma, La 70360 (985)262-2228 www.UnlimitedMR.com
NAME:*
First and Last
Address*

Street Address

Street Address Line 2

City State

Zip Code
Home - Phone Number

Area Code Phone Number
Cell - Phone Number*

Area Code Phone Number
EMAIL ADDRESS:
example@example.com
How did you hear of us?
Vehicle Information

Fill in as much information as you know. We can finish the rest When the vehicle arrives.
VIN:
Vehicle Identification Number
License Plate / State
MO/Year:
MAKE:
MODEL:
COLOR:
Mileage
Transmission
Drive Type
Warranty Policy (If Applicable)
If you have an aftermarket warranty, list it we can try to lower the cost of repairs. We accept all warranty companies.
VEHICLE Concerns And/Or Work to be preformed:*
Storage Fees

Storage fees of $20.00 a day will be charged if vehicle is not accounted for 7 days after notification of estimated or completed repairs also to include abandonment.
Mechanic Lien

An express mechanic’s lien is acknowledged on the above vehicle to secure the amount of repairs thereto. In event legal action is necessary to enforce this contract, I the above will pay reasonable attorney’s fees and court costs.
PLEASE READ CAREFULLY, Check only one of the following Statements below.
I Request a written, oral or texted estimate. I do not request a written estimate, please complete all the necessary repair(s). No matter the cost. I do not request a written estimate, if the repair cost do not exceed* $ cost not to exceed
Optional Additional Comments or Information
Old parts and Cores will be junked or returned as cores unless otherwise instructed below.

I WANT the old replaced parts returned to me and agree to pay (If any) core charges associated.
DATE

MonthDay Year
Date
I hereby authorize Unlimited Maintenance and Repair (UMR) to repair my vehicle based upon the agreed repairs. I agree to allow your employees to operate the above vehicle for purposes of repairing, testing, inspection or delivery. UMR will not be held responsible for loss or damage to my vehicle or articles left in my vehicle in case of fire, theft or accident or any other cause including acts of god. UMR cannot be held liable for unintentional damages to parts because of rust, dry rot, aged, brittle or any other damages beyond our reasonable control. I agree that UMR is not responsible for delays caused by unavailability of parts, or delay in parts shipment. In the event of work decline, I understand there may be charges, including but not limited to the following: Towing, Storage, Administrative fees, Diagnostic fees, restocking fees, labor charges, legal and recovery fees. All fees are due and are my responsibility prior to pick up/delivery of my vehicle, unless prior arrangements have been made. Labor Hourly Rate $107.70, Mitchell Labor Repair Times.
Accepted by:

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Should be Empty:

REPAIR AUTHORIZATION FORM

Unlimited Maintenance and Repair LLC

Vehicle Information

Storage Fees

Mechanic Lien