Vehicle Drop Off Form printable pdf download

Mevert Automotive & Tire Center

Vehicle Drop Off Form

Please fill out this form and place in an envelope from the Night Drop Box.

Please park your LOCKED vehicle in customer parking area.

Place your KEYS in the envelope and seal.

Place envelope through the slot in the wall under the drop box envelopes.

Please phone us early to confirm repair details. We open at 7:30am M-F

Owner & Vehicle Info:

Your full Name:____________________________________

Address:___________________________________________

City:______________________________________________

Zip Code:__________________________________________

Home/cell phone #:_________________________________

Work/Daytime phone #:______________________________ (please circle best number to call)

May we text message you? Yes | No (please circle)

E-mail:____________________________________________

Vehicle make & model:______________________________ (eg. GM Corvette)

Year:______________________________________________

License plate:_____________________________________

Work to be performed / Description of problem:

Maximum amount allowed before contacting you for authorization:

(Please sign (initial) one)(initial diagnosis usually require a minimum of $40-$70)

$100

________

$250

________

$500 ________

$_____ ________

Desired vehicle pickup time?_______________

Terms: Cash (unless other payment arrangements made prior to starting work)

I hereby authorize the work and repair herein set forth to be done by Mevert Automotive, together with the

furnishing by Mevert Automotive of the necessary parts and other material for such repair, and agree: that

Mevert Automotive is not responsible for any delays caused by unavailability or delayed availability of parts or

material for any reason; that Mevert Automotive neither assume nor authorize any other person to assume for

Mevert Automotive any liability in connection with such repair; that Mevert Automotive shall not be responsible

for loss of or damage to the above vehicle, or articles left therein, in case of fire, theft or other cause

beyond Mevert Automotive’s control; that an express mechanic's lien is hereby acknowledged on the above vehicle

to secure the amount of repairs thereto; that Mevert Automotive employees may operate the above vehicle on

streets, highways or elsewhere for the purpose of testing and/or inspecting such vehicle.

Signature:______________________________________ Date:___________________ Time:_________

210 East Massachusetts St, Steeleville, IL 62288 | (618) 965-9609

Vehicle Drop Off Form