AutoRelay - Customer Service Request

AutoRelay - Customer Service Request
AutoRelay connects you with screened, vetted service providers who come to your location to assist with basic vehicle needs. Please complete the form below to request service.
1 Customer Information
Full Name
Phone Number
Format: (000) 000-0000.
Email Address
example@example.com
2 Vehicle & Service Location Information
Service Address (where the vehicle is located)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Vehicle Year / Make / Model
Vehicle Color
Example: Black, White, Silver, Red
License Plate Number
The provider will photograph the license plate upon arrival to confirm the correct service vehicle and departure.
Roadside & Quick Service

★ Roadside & Quick Service ★Flat-rate pricing. No guesswork. You’ll know the cost upfront, and we come to you. Services are performed roadside or curbside when it’s safe to do so. If conditions aren’t safe, we’ll let you know before starting. If anything additional comes up, we’ll always get your approval first — no surprises.

Do you want AutoRelay to source the required parts for this service?Parts sourced by AutoRelay may include a standard materials and handling markup and come with a manufacturer warranty.Customer-supplied parts are installed as-is and are not covered under AutoRelay’s warranty.
4 Safety & Location Check
Is the vehicle located on level ground suitable for service ?
Is there adequate lighting at the service location?
If No / Unsure, please explain:
Vehicle Access:
Vehicle Access
5 Transportation to Safety
AutoRelay does not provide towing or long-distance transportation.
- Safety will be to your closest destination, home, hotel etc. of your choice.
- Limited assistance to a safe nearby location (such as a home, hotel, or public area) may be available at provider discretion. Under 1 mile.
6 Scheduling
Select your preferred service date below. Submitting this form or paying an invoice does not confirm a specific appointment time. AutoRelay will confirm your appointment separately after verifying provider availability.

AutoRelay is open 24 hours a day. Service appointments depend on provider availability in your area.

Same-day or emergency service carries an additional $30 expedited scheduling fee and requires availability confirmation before booking.

Confirmed arrival windows are estimates. Provider availability, earlier jobs running longer than expected, traffic, weather, accidents, or safety concerns can require a scheduling change. We will notify you promptly when we become aware of a change and coordinate another available time.

If AutoRelay cannot accommodate your confirmed appointment and you decline rescheduling, we will refund payment for services not performed.
Appointment

7 Important Acknowledgements
AutoRelay – Service Scope & Safety Acknowledgment

How AutoRelay Works: AutoRelay connects customers with independent service providers for on-scene vehicle assistance and basic automotive services.

Providers perform only the services selected at booking and may decline or stop work if conditions are unsafe or outside the approved scope.

What AutoRelay Does Not Provide

AutoRelay does not provide:Towing services
Passenger transportation or rideshare services
Mechanical diagnostics or major repairs

Service Scope & Completion

Services are limited to the scope selected at booking.

If a requested service is determined to be unsafe or out of scope upon arrival, the provider may mark the job as Unable to Complete.

Customer-Supplied Parts Disclaimer

Customers may choose to supply their own parts (including oil, filters, batteries, or accessories). AutoRelay and its providers are not responsible for incorrect, defective, incompatible, or previously used parts supplied by the customer. Labor charges apply regardless of part condition once service has begun.

Safety Assistance (Limited)

When necessary for immediate safety only, a provider may assist a customer in reaching a nearby safe location (such as a home, hotel, or public area), subject to the following:

Assistance is limited to under one (1) mile
Offered at provider discretion only
Intended for safety, not convenience
Not guaranteed or advertised as a service
No fee is charged or accepted for transport assistance

This is not a transportation service.

Ride Coordination & Stay-With-You Support

If additional transportation is required, providers may:Remain with the customer at the scene
Assist in contacting Uber, Lyft, taxi, tow service, or a family member
Help coordinate pickup and ensure a safe transfer.

In these situations: Transportation is arranged directly between the customer and the third-party service.
AutoRelay does not set prices, collect fares, or assume liability.
Customers may be charged for on-scene assistance time, not transportation.

Pricing & Additional Costs

Prices shown are for labor and assistance only. Parts, fluids, towing, and transportation are not included and are billed separately.

After-Hours Premium:

A $30 after-hours service premium applies to services scheduled between 10:00 PM and 6:00 AM. This fee is charged in addition to the selected service price.

Service times may vary based on vehicle condition, access, and safety considerations.

Independent Providers

AutoRelay providers are independent contractors, not employees or agents of AutoRelay.

Providers retain discretion over:

Job acceptance
Safety decisions
Service execution

Payments & Platform Use

All services must be booked and paid through the AutoRelay platform.

Payments made outside the platform are not supported or protected by AutoRelay.
Important Information & Acknowledgment
AutoRelay collects only the information necessary to coordinate your requested service, including contact details, vehicle information, and service location. This information is shared only with the assigned independent service provider to complete your request and is not sold or shared for marketing or unrelated purposes. AutoRelay is a service coordination and referral platform and does not perform mechanical repairs directly.Pricing shown reflects base service rates. Services scheduled between 10:00 PM and 6:00 AM include a $30 after-hours service premium. Some services include a standard service time; if additional time is required, approval will be requested before work continues, and additional time is billed at $25 per 30 minutes.I understand services are subject to safety conditions, access, and service scope. I confirm that any required lock box or vehicle access will be properly installed and accessible at the scheduled service time. If you cancel an approved job after AutoRelay has started coordinating it, AutoRelay will deduct a $150 job coordination fee from any eligible refund. This fee covers time spent sourcing or ordering parts, coordinating the provider and appointment, and handling the cancellation. The fee does not apply if AutoRelay cancels or is unable to provide the agreed service. Where allowed by law and the payment processor’s rules, AutoRelay and the customer can agree in writing to refund installments. The full balance will be paid within two months of refund approval, or sooner if a shorter deadline applies. AutoRelay can issue installments ahead of schedule.
I acknowledge that AutoRelay providers may take photos of my vehicle, including the license plate, solely for service verification, documentation, and quality assurance purposes (such as confirming arrival, correct vehicle, and job completion).License plate photos and vehicle images are not used for marketing or public-facing content and are stored securely for internal records only. If AutoRelay wishes to use any de-identified vehicle photos for marketing or promotional purposes, separate consent will be requested.
Please Help us help you! Marketing Photo Permission (Optional) I give AutoRelay permission to use de-identified vehicle photos taken during service for marketing or promotional purposes. No personal identifying information will be shown, including: license plates, VIN numbers, names, addresses.
8 Additional Notes
Is there anything AutoRelay or the Provider should know before the appointment? Examples: Gate/access instructions, pets on property, vehicle starting issues, parking limitations, important symptoms or concerns.
Referral code (optional) If someone referred you to AutoRelay, enter the code they shared with you. If you don’t have a code, leave no referral code.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Should be Empty:

AutoRelay - Customer Service Request

1 Customer Information

2 Vehicle & Service Location Information

Roadside & Quick Service

4 Safety & Location Check

Vehicle Access:

5 Transportation to Safety

6 Scheduling

7 Important Acknowledgements

Important Information & Acknowledgment

8 Additional Notes