Check-in Form

CUSTOMER CHECK-IN FORM

Name(Required)

Address(Required)

Email(Required)

Phone

VIN#(Required)

Year / Make / Model(Required)

What type of mechanical / wiring problem do you have?(Required)

Are there any other problems you have noticed?(Required)

When did the problem(s) begin and how often do they occur?(Required)

Are they related to temperature / weather?(Required)

Checkbox(Required)

I hereby authorize Fitz’z Service, Inc. to provide me with a verbal or written estimate for repair work to be done along with the necessary material and hereby grant you and/or your employees permission to operate the vehicle described for testing and/or inspection. Express mechanic's lien is hereby acknowledged on above vehicle to secure the amount of repairs thereto. Gateway Vehicle Inspection Program (GVIP): I understand that I can have emission service and/or adjustments done elsewhere. I hereby waive this right. All Parts removed will be discarded unless instructed otherwise. FITZ'Z SERVICE INC IS NOT RESPONSIBLE FOR LOSS OR DAMAGE TO CARS OR ARTICLES LEFT IN CARS IN CASE OF FIRE, THEFT OR ANY OTHER CAUSE. A STORAGE CHARGE OF $50 PER DAY WILL BE APPLIED BEGINNING ON THE 2nd CALENDAR DAY AFTER I AM NOTIFIED THAT MY REPAIRS ARE COMPLETED.

Signature of Applicant(Required)

Date(Required)