Windshield Repair Liability Release Form

Windshield Repair Liability Release Form
Due to the process of repairing laminated glass and the unstable properties of broken and damaged glass, customers should know that there are always certain risks associated with the repair of damaged auto glass. For instance, the damaged area could develop new cracks, or existing cracks could increase in length during the repair process. This problem is extremely rare and occurs in less than 1% of all windshield repairs. In the unlikely event that Bluff City Autoglass Repair LLC cannot repair the damage, our liability is limited to a refund of the amount charged for the attempted repair.
I hereby grant permission to Bluff City Autoglass Repair LLC to perform all necessary and authorized repairs to my vehicle's windshield on my premises. I understand that no damaged windshield can be restored 100% to pre-damaged condition and that the repair will not be invisible when complete. I understand that the purpose of repair is to stop further damage, improve the clarity of the damage site, and to restore structural integrity to the windshield/vehicle.*

I understand and agree
I understand and agree
I understand and agree
By signing below, I agree to hold harmless, Bluff City Autoglass Repair LLC, its owners, affiliates, employees, agents, and representatives from any and all liability, injury, loss, damages whether personal or real, expenses, whether tangible or intangible, litigation costs by which they may incur in relation to the repair of my vehicle on my premises.
Name*

First NameLast Name
Email
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Vehicle Make
Vehicle Model
Date Signed*

MonthDayYear
Date
Signature*

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