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8.5 x 11.0" customer write-up form 2 sides
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VIN #
NAME:
ADDRESS:
TELEPHONE #’s HOME
WORK
TODAY
CELL/PAGER
# CONCERN
PRIORITY
# CONCERN
PRIORITY
# CONCERN
PRIORITY
# CONCERN
PRIORITY
# CONCERN
PRIORITY
APPOINTMENT
WAIT
SHUTTLE
RENTAL
READY BY
METHOD OFPAYMENTCASHCREDITCARDCHECK(PRIORAPPROVAL)
OTHER
MISCELLANEOUSSHOP SUPPLIESAND/OR WASTEDISPOSAL CHARGE[s.559.904(4)]THIS CHARGEREPRESENTSCOSTS ANDPROFITS TO THEMOTOR VEHICLEREPAIR FACILITYFORMISCELLANEOUSSHOP SUPPLIES ORWASTE DISPOSAL.
PPLLEEAASSEE RREEAADD CCAARREEFFUULLLLYY,, CCHHEECCKK OONNEE OOFF TTHHEESSTTAATTEEMMEENNTTSS BBEELLOOWW AANNDD SSIIGGNN:: II UUNNDDEERRSSTTAANNDDTTHHAATT UUNNDDEERR SSTTAATTEE LLAAWW,, II AAMM EENNTTIITTLLEEDD TTOO AAWWRRIITTTTEENN EESSTTIIMMAATTEE,, IIFF MMYY FFIINNAALL BBIILLLL WWIILLLLEEXXCCEEEEDD $$110000..0000.._______ I REQUEST A WRITTEN ESTIMATE.
_______ I DO NOT REQUEST A WRITTEN ESTIMATE AS LONG AS THE
REPAIR COSTS DO NOT EXCEED $_________________.
THE SHOP MAY NOT EXCEED THIS AMOUNT WITHOUT
MY WRITTEN OR ORAL APPROVAL.
________I DO NOT REQUEST A WRITTEN ESTIMATE.
SSIIGGNNEEDD:: XX ______________________________________DDAATTEE:: ____________..
REPLACED PARTS REQUESTED
ALL PARTS ARENEW UNLESSOTHERWISEINDICATED
LABOR CHARGES ARE BASED ON A FLAT RATE PER HOUR. THE HOURS ARE PUBLISHED IN A FLAT RATE MANUALWHICH REFLECTS AN AVERAGE TIME REQUIRED FOR THE PERFORMANCE OF SPECIFIC VEHICLE REPAIRS, ANDWHICH MAY, THEREFORE, BE EITHER MORE OR LESS THAN THE ACTUAL CLOCK TIME IN ANY GIVEN INSTANCE.
STORAGE CHARGES: No storage charges will accrue or be due and payable 3 working days from the date you are notifiedthat the work on your vehicle has been completed. After that date, the daily charge for storage of your vehicle will be $15.00.
NOTE: Estimate amounts are based on initial inspection only. Additional parts and labor may be required. You will be notifiedupon completion of any diagnostic work necessary to estimate the cost of repair, or if the actual charges will exceed the writtenestimate, including any additional authorized charges, by $10 or 10%, whichever is greater, not to exceed $100.00. If you areso notified, you may orally or in writing authorize, modify or cancel the order for repair.
PARTS AND LABOR ARE GUARANTEED FOR 12 MONTHS UNLIMITED MILES.LIMITED WARRANTY: The only warranties applying to the part(s) in accordance with this estimate are those that may beoffered by the manufacturer. The seller hereby expressly disclaims all warranties, either express or implied, including anyimplied warranty of merchantability or fitness for a particular purpose, and neither assumes not authorizes any other person toassume for it any liability in connection with the sale of products or services sold under the terms of this estimate. Seller doesnot guarantee the work performed in accordance with this estimate will correct any problem specified on the description of thecomplaint.
I understand that all parts and accessories sold or used are subject to the Federal Magnussion-Moss Act and the consumer merchandise purchased is under LIMITED WARRANTY by themanufacturer and the written terms and conditions thereof are available for my inspection.
I hereby authorize the repair work herein set forth to be done along with the necessary material and agree that you are notresponsible for the loss or damage to vehicle or articles left in vehicle in case of fire, theft or anyother cause beyond your control (PLEASE REMOVE ALL PERSONAL BELONGINGS FROMVEHICLE) or for any delays caused by unavailability of parts or delays in parts shipment by the supplier or transporter. Ihereby grant you and/or your employees permission to operate the vehicle herein described on streets, highways or elsewherefor the purpose of testing and/or inspection. An express mechanicʼs lien is hereby acknowledged on above vehicle to securethe amount of repairs thereto. Not responsible for damage from freezing due to lack of antifreeze.
Customer Signature X ___________________________________________ _____________ .
DATE PROMISE DATE YEAR - MAKE - MODEL TAG # MILES
ORIGINAL DATE TIME BYESTIMATE $ADDITIONAL DATE TIME BYAUTHORIZEDAMOUNT $REVISED DATE TIME BYAUTHORIZEDESTIMATE $NAME AND PHONE NUMBER OF OTHER PERSON WHO MAY AUTHORIZE ADD’L REPAIRS
SEE REPAIR ORDER FOR ALL TERMS AND CONDITIONS AND SIGNATURESYES NO
© Copyright 2007 Bob Witham’s Automotive Service Marketing Systems, P.O. Box 1557, St. Augustine, FL 32085 1.904.940.0006
DISPOSAL FEESBATTERY, ea $ 1.50(s.403.7185)TIRES, ea $ 1.00(s.403.718)
SSEERRVVIICCEE RREEPPAAIIRR OORRDDEERR RREEQQUUEESSTT -- CCOOGGGGIINN TTOOYYOOTTAA aatt tthhee AAVVEENNUUEESS1100556644 PPhhiilliippss HHiigghhwwaayy,, JJaacckkssoonnvviillllee FFLL 3322225566-- 11..990044..226622..00333388 ((MMVV##0022442233))
MMIINNIIMMUUMM DDIIAAGGNNOOSSTTIICC && EESSTTIIMMAATTEE FFEEEE -- $$4422..5500
SSEERRVVIICCEE RREEPPAAIIRR OORRDDEERR RREEQQUUEESSTT -- CCOOGGGGIINN TTOOYYOOTTAA aatt tthhee AAVVEENNUUEESS1100556644 PPhhiilliippss HHiigghhwwaayy,, JJaacckkssoonnvviillllee FFLL 3322225566-- 11..990044..226622..00333388 ((MMVV##0022442233))
© Copyright 2007 Bob Witham’s Automotive Service Marketing Systems, P.O. Box 1557, St. Augustine, FL 32085 1.904.940.0006
Basic: Oil & Filter Change, 19-point Inspection $ 24.95
Silver: Oil & Filter Change, 19-point Inspection,
Plus 2 Wiper Blades ............................ $ 39.95
Gold: Oil & Filter Change, Plus 1 Air Filter .... $ 39.95
Platinum:Oil & Filter Change, Plus 1 Air Filter,
Plus 2 Wiper Blades ............................ $ 59.95
Tire Rotate & Balance, 4 wheel ................................ $ 34.95
Wheel Alignment, 4 wheel ....................................... $ 69.95
Brake Job, front (Pad replacement) ................................ $ 109.95
Brake Service, Rear (Clean & adjust) .............................. $ 39.95
Automatic Transmission Service ......................... $ 59.95
Automatic Transmission Service, Type 4 ............. $ 69.95
Manual Transmission Service ............................. $ 39.95
Differential Service ............................................. $ 39.95
A/C Refresher Service ......................................... $ 59.95
Fuel Induction Service ......................................... $ 69.95
Cooling System Service ........................................ $ 49.95
Battery Replacement ........................................... $ 69.95
ADDITIONAL SERVICESTiming Belt Replacements .......................... 4 Cyl $ 219.95
6 Cyl $ 259.95
8 Cyl $ 349.95
EXPRESSSERVICES
MOC SERVICESAutomatic Transmission Flush ............................................ $129.95
Automatic Transmission Flush, Type 4 ................................. $149.95
Power Steering Flush ........................................................... $109.95
Cooling System Flush ........................................................... $ 89.95
Brake Fluid Flush ................................................................ $ 99.95
Battery Service .................................................................... $ 19.95
See your Service Advisor for Details
Renewable to a Maximum8 Year/120,000 MileGold MedalLimited WarrantySee your Service Advisor for Details
