Intake & Race Waiver

PSI Proformance INC
200 W 5th Street
Suite 104
Lansdale Pa, 19446
PSI Proformance Client Intake

This form must be completed in its entirety.
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
E-mail*
example@example.com
Existing Client?*
VEHICLE INFORMATION
Year, Make & Model*
Color*
Does the vehicle run?*
Does the engine start and stay running?
Does the vehicle drive?*
Does the vehicle move under its own power?
Save Old Parts?*
Requested Work?*
I, {fullName3}, understand that PSI Proformance Inc and employees are not responsible for items left in vehicles. Please Remove all Personal belongings from vehicle upon drop off. By signing below You agree to allow PSI Proformance to complete approved work as needed and this may include driving, testing or inspecting vehicles. We have the right to refuse service on any vehicle for any reason. we are not responsible for any vehicle left outside. PSI is not responsible for any loss or damages from theft, Fire, Accident, or any other case beyond our control. Unless explicitly stated otherwise, all products sold by PSI Proformance, Inc. are designated Race Only and are solely for competition/off road use limited to racing formally sanctioned by a recognized racing organization. Any other use, including recreational off- road use, may be in violation of local, state, and Federal laws. PSI Proformance does not implicitly or explicitly confirm the legality of using any products it sells on public roads; that is entirely the responsibility of the consumer.*

I agree
Signature*

Clear
{fullName3}
Date*

MonthDayYear
Date

PSI Proformance INC
200 W 5th Street
Suite 104
Lansdale Pa, 19446
Acknowledgement of Compliance for Competition / Racing Use
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Year, Make & Model*
I, {race-waiver-name}, am purchasing products and/or services from PSI PROformance Inc. for a vehicle with the intent of using these such products and/or services for RACING/COMPETITION ONLY. I do not intend and will not use this vehicle and/or the products and/or services installed therein, for on-road use or recreational use. I understand that some or all of the parts being purchased or installed by PSI may not comply with federal, state, and/or local laws, ordinances, and/or regulations for on-road use and/or recreation use. I acknowledge PSI PROformance Inc. has made me aware that certain parts are intended for Racing/ Competition Only and not meant to be used on a road car, street car or even on a recreational off-road vehicle, and that I will only use such parts in a vehicle in compliance with these rules. This acknowledge of compliance shall be in force for all current and future purchases from PSI PROformance Inc.*

I agree
Signature*

Clear
{race-waiver-name}
Date*

MonthDayYear
Date
Should be Empty:

PSI Proformance Client Intake

Acknowledgement of Compliance for Competition / Racing Use