(PLEASE READ CAREFULLY AND COMPLETE THE FORM BELOW)
With the following information, we will be able to resolve your questions or concerns and communicate with you in the most effective and convenient manner possible.
CUSTOMER INFORMATION AND AUTHORIZATION TO PROCEED
Attention: Please complete ALL items on the following form.
Authorized and Accepted: Candy Apple Custom Inc. is hereby authorized to make the specified repairs to my vehicle. I understand that payment in full will be due upon the release of the vehicle, including additional supplemental damage charges, and hereby grant Candy Apple Custom Inc. and their employees permission to operate the car, truck, or vehicle herein described on the streets, highways, or elsewhere for testing and evaluating vehicle systems in accordance with manufacture procedures and insurance claim determinations; including electronic system scanning, testing, measuring, inspections, vehicle data collection and documentation in relation to vehicle repairs and assessments. An express mechanic’s lien is hereby acknowledged on the above vehicle to secure the amount of repairs thereto. It is acknowledged that your outdoor storage fee is $95 per day when applicable. Old parts removed from the vehicle will be discarded unless otherwise instructed prior to the start of repairs.
Candy Apple Custom Inc. will not be responsible for the loss or damage to vehicle or articles left in the vehicles, in case of fire, theft, accident, or any other cause beyond our control. Not responsible for window tint.
We accept the following means of payment:
1. Insurance Check or Payment Check
2. Visa or Mastercard Debit or Credit
NO PERSONAL CHECKS ACCEPTED
AMERICAN EXPRESS & DISCOVER CARDS NOT ACCEPTED
ALL DEDUCTIBLES, CUSTOMER PAID REPAIRS, BETTERMENT, AND INSURANCE MUST BE PAID TIME OF PICK-UP.
VEHICLES NOT PICKED UP WITHIN 48 HOURS OF COMPLETION STORAGE FEES OF $95.00 PER DAY WILL BE CHARGED.
Repair Order Authorized By:_______________________________________ Date: __________
POWER OF ATTORNEY: I do hereby appoint the aforementioned business as my attorney in fact to accept on my behalf any and all checks, drafts, or bills of exchanged for deposit to the aforementioned business account for the repairs on my vehicle(s).
Accepted By: ___________________________________________________ Date:___________
THANK YOU FOR CHOOSING OUR SHOP
WE APPRECIATE YOUR BUSINESS
Fax Completed forms to 770-943-5025