Community Matters

102 Sharon Road King William, VA 23086

Driver's Name*

First NameLast Name

Phone Number*

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Year*

Make*

Model*

License Plate Number*

Service Requested (Part may need to be order and my require a return visit)*

Covenants*

1. Services ProvidedCustomer acknowledges and agrees that the auto repair and maintenance services ("Services") performed on their vehicle will be conducted by individuals currently in training to become professional automotive technicians ("Trainees") under the supervision of qualified staff.2. Assumption of RiskCustomer understands and accepts that the Services may not meet the same level of expertise or proficiency as those provided by certified and experienced technicians. Customer voluntarily assumes all risks associated with the Services, including but not limited to, the possibility of incomplete, delayed, or unsatisfactory repairs.3. Release of LiabilityCustomer agrees to release, waive, and hold harmless Mechanics of Faith, its employees, Trainees, supervisors, affiliates, and agents from any and all claims, damages, costs, or liabilities, including but not limited to personal injury, property damage, or financial loss, arising out of or related to the Services provided.I understand that I will be responsible for paying Mechanics of Faith program fees for services after they are preformed and have been approved

Driver's Signature

Date Signed

Date

Mechanics of Faith helps anyone in need that meets our guidelines regardless of race/ ethnicity, religion, or gender.

Community Matters

Driver Information

Car Details