automotive electric diagnostics and auto repair

Work Authorization Form

Please take a moment to fill out the form

First Name

Last Name

Phone

Vehicle year/make/model

Terms and Conditions

• By signing this form, I understand and agree to the following terms and authorize deBruin Automotive LLC dba Village Auto Repair to repair the above-mentioned vehicle. I hereby authorize the paid diagnostics of vehicle for estimate. The estimate of repairs includes parts, labor. We may find on further inspection, additional parts or repair needed which may adjust the final total. You may be contacted for additional monies to correct these additional repairs. We are not responsible for loss of damage to your vehicle from fire, theft, accident, or any other cause beyond our control. Our employees, at your risk, will make test drives up to highway speeds for diagnosis and final check. Diagnostics fees allways apply and are charged hourly. An expressed mechanic’s lien is hereby acknowledged on the above vehicle to secure amount of repairs thereto. Customer agrees that he/she will be jointly and severally responsible and liable for payment of all charges for labor, parts, material, and accessories, sublet repairs to the vehicle, and any other charges incurred under this Agreement and payment in full shall be made prior to the release of the vehicle. If the vehicle is not picked up within five (5) days after Village Auto Repair has notified the customer that the repairs are completed, Village Auto Repair may charge daily storage fees at rates that are not to exceed $50.00 per day. By signing this form you agree to receiving repair updates and estimates by text. You can opt out by replying STOP to the text.

Street Address

City

Postal / Zip code

Region/State/Province

Date

Your Signature

Call NOW 480-964-6567

19 N Miller St Mesa

Village Auto Electric

We fix where others failed since 1949

Work Authorization Form