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“Service you can Trust”

13180 Westpark Dr. Houston, TX 77082 281-531-9999 281-531-4162
Date Year, Make, Model

Name License Plate

Phone Odometer

Address VIN

City, Zip Code Inspection Date Color

Email How did you hear about us?

Customer Concerns Items Serviced

Recommendations

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I hereby authorize the repair work to be done along with the necessary parts and
materials and hereby grant you and/or your employee’s permission to operate the
vehicle herein described on streets, highways or elsewhere, at your discretion, for
the purpose of testing and/or inspection. An express mechanics lien is hereby
acknowledged on the above vehicle to secure the amount of repairs there to. Not
responsible for damage or articles left in car in case of fire, theft or any other cause
beyond our control.
Payment for repairs is due when picking up vehicle unless prior arrangements are
authorized.

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