INTAKE FORM

I hereby authorize Great Auto Repairs to start repair work on the said vehicle above. I agree to secure the payment of the vehicle in a timely manner and that all payments must be made in full, at time of picking up the vehicle. WE DO NOT DO INSTALLMENT PLANS.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

VIN or PLATE NUMBER

How will you be paying?

Insurance

Self Pay

Fleet

Other

Disclosures

I understand that I must pick up my vehicle within 3 business days of being notified my vehicle is finished of repairs. If my vehicle is here longer than 3 business days, I will be liable for storage fees of $50 dollars per day due to our limited parking at our facilities. I understand that if I cannot pay for the repairs, if payment/s are not made in full, and/or I cannot pay my storage fees to retrieve my vehicle, on the 30th day of being notified to pick up my vehicle, Great Auto Repair may seek a Mechanic's Lien to recover their costs, labor, time, and monies into the repair. I understand I may also be held responsible to pay for reasonable attorney's fees and court costs in the event that legal action becomes necessary to enforce this contract.