Vehicle Repair Completion & Pickup Acknowledgment Form

Vehicle Repair Completion & Pickup Acknowledgment Form
Customer Name:*
Vehicle Year/Make/Model:*
VIN (last 6 digits):*
Date of Pick-Up:*

MonthDayYear
Date
By signing below, I acknowledge the following:
1. I have picked up my vehicle from Alpha Dent Solutions.
2. I have reviewed the completed repairs and am satisfied with the work performed.
3. I understand that any concerns regarding the repair must be brought to Alpha Dent Solutions' attention within 3 business days of pickup.
4. I have received all of my belongings and keys.
5. If applicable, I have received a copy of the final invoice and/or insurance paperwork.
Notes (if any):
Customer Signature:*

Clear
Date:

MonthDayYear
Date
Alpha Dent Solutions Representative:
Should be Empty: