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REPAIR ORDER REQUEST CUSTOMER DATA SHEET (Print This Page and Fill In The Requested Information) I hereby authorize the repair work listed to be done along with the necessary material and agree that you are not responsible for loss or damage to the vehicle, articles left in the vehicle, in case of fire, theft, or any other cause beyond your control or for any delays in parts shipments by the supplier or transporter. I hereby grant you and/or your employees permission to operate the vehicle herein described on streets, highways, or elsewhere for the purpose of testing and/or inspection. All express technician's lien is hereby acknowledged on listed vehicle to secure the amount of repairs thereto. PLEASE INITIAL ONE:: ___YES or ___NO |
All data in red must be completed before work can begin on the vehicle.
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ll information on this R.O., including phone number, is true and correct.
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Notice Pursuant to § 70.001, Texas Property Code I am the person or agent acting on behalf of the person, who is obligated to pay for the repair of the motor vehicle subject to the repair agreement. I understand the vehicle is subject to repossession in accordance with § 9.609, Texas Business and Commerce Code, if payment for the repair of the motor vehicle by a check, money order, or a credit card transaction is stopped, dishonored because of insufficient funds, no funds, or because the maker or drawer of the order or the credit card holder has no account or the account upon which it is drawn or the credit card account has been closed. PLEASE INITIAL ONE:: ___YES or ___NO |
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| DESCRIBE THE WORK YOU WANT DONE: ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ |
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