Tires International & Auto Center LLC

For your convenience - When using our early morning or late evening drop-off service:

1. Complete the following information then print and sign this form.
Leave your LOCKED car on our lot.
Place your keys and this form in the mail slot .
Contact Information:
Vehicle Information:
City: Zip:
License Number:
Home Phone:
Business Phone:
Pickup Day/Time: AM PM

Check the service(s) you want performed:

Mile Inspection Mile Diagnosis
State Inspection
Emissions Inspection
Chassis Lubrication
Change Engine Oil
Change Oil Filter
Change Transmission Fluid
Repack Front Wheel Bearings
Tune Engine
Replace Brakes
Replace Exhaust
Adjust Brakes
Replace Belts
Replace Hose
New Battery
Inspect/Repair Air Conditioning
Inspect/Repair Heating System
Replace Shocks
Check Transmission
Replace Radiator
Repair Lights
Oil Leaks – Front
Oil Leaks – Rear
Replace Clutch
Replace Tires: All Four Front Rear
Other Work or Additional Information:
I hereby authorize the above repair work to be done along with the necessary materials, and 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. An express mechanic’s lien is hereby acknowledged on the above vehicle to secure the amount of repairs and/or service thereto. Our facility is not responsible for unavailability of parts or delays in parts shipments neither beyond our control nor for loss or damage to vehicle or articles left in vehicle in case of fire, theft, or any other cause beyond our control.

Please Sign Here______________________________     Date:___________________________
© Tires International Auto Center LLC 2009. All Rights Reserved