Automotive Lockout Form

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This one is a classic:
name-----------------------------date----/-----/---- address---------------------------------------------- ---------------------------------------------------------
[_quantity__[____description_______[_price__]_amount__] [_quantity__[____description_______[_price__]_amount__][_quantity__[____desc ription_______[_price__]_amount__][_quantity__[____description_______[_price __]_amount__][_quantity__[____description_______[_price__]_amount__][_quanti ty__[____description_______[_price__]_amount__][_quantity__[____description_ ______[_price__]_amount__][_quantity__[____description_______[_price__]_amou nt__][_quantity__[____description_______[_price__]_amount__][_quantity__[___ _description_______[_price__]_amount__][_quantity__[____description_______[_ price__]_amount__][_quantity__[____description_______[_price__]_amount__]
_____________________________________Tax[_______] ____________________________________Total[_______]
Received by X___________________________________
Invoice number Thank You
Reply to
Roger Shoaf
automotive lockouts?
__________________________________________________________ AUTHORIZATION & HOLD HARMLESS RELEASE AGREEMENT
I do hereby authorize and hold harmless all persons associated in any way with the unlocking of said Vehicle and hereby promise to release said person(s) of any civil or criminal charges or any property damage that may occur in consideration of the unlocking of said vehicle.
In witness whereof, I have placed my signature here on the ______day of____, 19__
Authorizing Party ___________________ Drivers License # ___________________ Vehicle Vin # ______________________ Authorized Party __________________________ (person to perform opening) _____________________________________________
Reply to
Emergency Service Authorization - Auto Please print all information
Date ____________________ Invoice # ______________________ Notes
Name __________________________________________________
Address ________________________________________________
City/St/Zip ______________________________________________
DL/ID# ___________________________ Exp/DOB _____________
Make _______________ Mod ____________ Color ____________
Lic# _____________ St. _______ Vin# ______________________
Year _________ Phone # ( ) ________ -- ______________
Location of Veh. _________________________________________
Locksmith ______________________________________________
Call Rec'd _________________________________________ Registered Owner Family Member Employee Agent
Dispatched __________________________________ Shop hours Evening Morning W/E Holiday Late night
Time arrived __________________________ Local ______________________________________
Time departed _________________________ Out of base area ______________________________
There HAS NOT been a previous attempt to unlock this vehicle.
Sig nature ________________________________________
There HAS BEEN a previous attempt to unlock this vehicle.
Signature ________________________________________
Authorizing Signature _______________________________________________
There will be a $25.00 charge on all returned checks. NO EXCEPTIONS!
My signature affirms that the above information is true and complete. I hereby authorize the Locksmith to perform the work indicated and accept responsibility for payment upon completion (Unless advanced credit approval). I agree to indemnify and hold blameless the Locksmith and the Lock Company in the performance of this work. I have disclosed any unusual problems that would affect the unlocking of this vehicle. An express mechanics lien is acknowledged on this vehicle to secure the fee for service provided thereto.
There will be a $25.00 paperwork fee & 1.5 % per month finance charge on all overdue invoices. All invoices are due 10 days from date of work.
Service call (inc 1ST 1/2 hour labor) $67.50 Parts $_____________________________________
Add'l repair labor $__________________________________ Total parts $________________________________
Total $___________________________________________ Sub-total _________________________________
PA/Phila sales tax $__________________________ Emer/svc/frm rev 04/04
Total $____________________________________
Reply to
You have to remember that when copy & paste is done here, a lot of info is jumbled together.
G'me a fax # & I'll send it properly.
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