Independenceonboarding

Eurofed Independence

6447 E Independence Blvd
Charlotte NC 28212
470.866.6397

Customer Check In

Name

Phone

Address

Cell

New Customer

Date of Birth MM/DD/YYYY (20% off On your Birthday Month)

How did you hear about us?

Vehicle Make & Model

Please describe the reason for your Eurofed visit:

Will These Repairs Be Covered By:

Extended Services Plan? Warranty?

NOTICE PURSUANT TO
GEORGIA PROPERTY CODE § 44-14-361
am the person or agent acting on behalf of the person, who is obligated to pay for the repair of the motor vehicle subject to the repair agreement. understand that the vehicle is subject to repossession in accordance with Georgia Business and Commerce Code, if payment for the repair of the motor vehicle by a check, money order or a credit card transaction is stopped, dishonored because of insufficient funds, no funds or because the maker or drawer of the order or the credit card holder has no account or the account upon which it is drawn or the credit card account has been closed. made

I hereby authorize the repair work listed hereon, Including sublet work, to be done along with necessary materials. You and your employees may operate the described vahide for purposes of testing, inspection or delivery at my risk. An express lien is acknowledged on said vehicle to secure the amount of repairs thereto. You will not be held responsible for loss or damage to vehicle or articles left in vehicle in case of fire, theft, accident or any other cause beyond your control. Customer agrees to all collection cost and/or attomey's fees in the event default is made in any payment due. If automobile is returned to customer without repair service being performed, a diagnostic and handling charge (including reassembling) will be

Customer Signature

Date