Smog Check Estimate

VALUE SMOG INC

B.A.R ARD # 266424

34820 Date Palm Drive Unit A

Cathedral City CA 92234

(760) 321-4383

If you completed this estimate form in the past, please enter your cell phone number in the box below without any spaces to Auto Complete Fields.

Last Name:*

First Name:*

Middle Name:*

Cell Phone Number:*

Numbers only (no spaces or special chars)

E-mail*

example@example.com

Street Address*

City*

State*

Zip Code*

Vehicle Year*

Vehicle Make*

Vehicle Model

Vehicle License Plate:

Use Capital Letters

Select one smog inspection from the list below*

Smog Inspection - Year 2000 & Newer VehiclePlus, Certificate ($8.25)

$51.75

Smog Inspection - Year 1999 & Older VehiclePlus, Certificate ($8.25)

$86.75

Subtotal

$0.00

Shipping

$0.00

Total

$0.00

How did you hear about us?

Will you be willing to recommend us?

YesNoMaybe

Terms & Conditions

  I hereby authorize the above Smog Inspection to be done & agree that inspection fee is due whether above vehicle passes or fails. I agree to pay the amount of the estimate on completion of the Smog inspection, which will not exceed the estimate without my permission. I agree that you are not responsible for loss or damage to vehicle or articles left in vehicle in case of fire, theft, accident, dynamometer testing, operation or any other cause beyond your control, include vehicle windows, doors, seats, hood release/lock & E brake. I hereby grant you and/or your employees' permission to operate the vehicle herein described on streets, highways or elsewhere for the purpose of testing, inspection and/or delivery at my risk. In the event legal action is necessary to enforce this contract, I understand that I am solely responsible for all costs including attorney's fees and court costs. I have read and understand the above & acknowledge receipt of an estimate. Customer may choose another Smog Check station to perform needed repairs, installations, adjustments, or subsequent tests.

By Signing & Submitting the Form I agree to the terms & conditions above & to receive the Smog Check Estimate via Email. "A paper copy of this estimate can be provided upon request" *

"A paper copy of this estimate can be provided upon request"

Note