Vehicle Drop- Off Form

VEHICLE DROP-OFF & WORK AUTHORIZATION FORM

NOTE: This form must be fully completed and signed by the vehicle owner or authorized agent before any inspection, diagnostic work, or repairs may begin. No work will be performed without a valid signature. Thank you!
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Year, Make & Model:
VIN or LICENSE PLATE # (if applicable)
Customer Concern (Describe in your own words what’s wrong with the vehicle) OR Requested Service
Frequency:
TERMS & CONDITIONS:

1. Authorization for Diagnosis and Estimates: I hereby authorize the repair shop to perform diagnostic testing, teardowns, and inspections on the vehicle listed above to determine the cause of the reported issues and prepare an estimate. I understand that diagnostic fees may apply even if I choose not to proceed with the recommended repairs.

2. Right to Refuse Service: The shop reserves the right to refuse service or stop work on any vehicle at any time due to safety concerns, unavailable parts, severe rust/corrosion, or unresolved billing disputes.

3. Vehicle Storage Policy: Vehicle Storage Policy: Vehicles left on the shop premises for more than 3 days (72 hours) after notification that repairs are completed, or after an estimate has been declined, will be subject to a storage fee of $50.00 per day starting on the 4th calendar day.

4. Limitation of Liability & Parts Delays: I agree that you are not responsible for loss or damage to vehicle or articles left in vehicle in case of fire, theft, or any other cause beyond your control or for any delays caused by unavailability of parts or delays in parts shipments by the supplier or transporter. 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 and/or inspection.

5. Limitation of Liability: The shop is granted an express possessory lien on the vehicle to secure the amount of repairs, storage, and diagnostics. Pursuant to Section 430.020 and Section 430.080 RSMo, vehicles left unpaid or unclaimed on repair shop property may be held by the shop and processed for a title transfer or public sale to recover outstanding debts. Temporarily releasing the vehicle to the customer does not waive the shop's statutory lien rights if a check bounces or a credit card chargeback is issued. A fee of $25.00 plus any bank fees will be assessed for any returned checks, and the customer will be liable for all collection and legal costs.
Signature
Should be Empty:

VEHICLE DROP-OFF & WORK AUTHORIZATION FORM