________________________ 
_____________________________ 
_______________________ 

_____________________ 
Dated: ________________________________________ 

Owners name: _____________________ 
_________________________ 
__________________________ 
Phone day: ____________________   Phone evening:
____________________ 

Make: _______________  Model: ______________ Color: ______________
Year: _______________ VIN: ________________ 

Mileage: ___________ 
Description of problem: 

_______________ 



Estimate: $  ( & no/100 dollars) 

Further authorization required to exceed estimate by _________ per
cent

The OWNER grants permission to _________________ to road test the
vehicle. The OWNER grants to ______________ an express mechanic's
lien on the vehicle to  secure costs of repairs and parts. 
NO WARRANTY IS PROVIDED ON PARTS OTHER THAN THOSE PROVIDED BY 
THE MANUFACTURER.



Date: _______________________________







___________________________________________________

OWNER