770-392-0700

1250 Dunwoody Village Parkway | Monday-Friday: 8:00-6:00 Saturday & Sunday: Closed

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Customer Information:


Name: _________________________________________________Date:__________________

Address: ______________________________________________________________________

Home# ________________________ Work#________________________ Other# _______________________

Email Address: _____________________________________________________________________________

Vehicle Information:

Make ________________Model ______________ Year__________ Tag# _______________ Color_________

VIN______________________________ _ Mileage______________________ Engine____________________


INSTRUCTIONS:

1.___________________________________________________________________________

2.___________________________________________________________________________

3.___________________________________________________________________________

4.___________________________________________________________________________

5.___________________________________________________________________________

6.___________________________________________________________________________

 

I hereby authorize the above inspections/repairs to be done along with the necessary material, and hereby grant you/or our employee permission to operate the vehicle herein described on streets, highways, or elsewhere for purpose of testing and /or inspection. An express mechanic's lien is hereby acknowledged on the above vechile to secure the amount of repairs thereto.


CUSTOMER SIGNATURE: X_____________________________________

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