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Auto Repair Release -Form Fill

Section One
Q1

There is a risk of spill of oil, grease, and/or other chemicals that may spill to my driveway, lawn, garage and/or any other personal property.
Q2

It is my responsibility for keeping away children, pets, relatives and guests away from the work area during the repair in order to avoid or mitigate the risk of personal injury.
Q3

I take responsibility for any damage to any property within the premises, whether real or personal, particularly including but not limited to, my driveway, landscaping, home, and/or personal injury, might occur.
Q4

The time spent in repairs through this method may take longer than usual. I accept and acknowledge any unforeseen delays or expenses which may accrue for not having the vehicle repaired on time.
Q5

During repair, there may be unforeseen damaged parts that the mechanic might not see and might get damaged. The mechanic shall inform me of these damaged parts and further assessment shall be made. This shall incur additional costs for repair on my part should I ask for it to be repaired as well.
Q6

Name

First Name
Q7

Name

Last Name
Q8

Address

Street Address
Q9

Address

Street Address Line 2
Q10

Address

City
Q11

Address

State / Province
Q12

Address

Postal / Zip Code
Q13

Email
Q14

Phone Number
Q15

Car Make
Q16

Car Model
Q17

Car Plate
Q18

Signature
Q19

Date Signed

Date