Automotive Lockout Form

This one is a classic:

name-----------------------------date----/-----/---- address----------------------------------------------

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[_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

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) _____________________________________________

g'day

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 $____________________________________

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.

Newnsie

Could you fax me a copy to (252)264-2388 Thanks Kathy Dumont Affordable Lock & Safe, LLC