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COMPANY VEHICLE MAINTENANCE REQUISITION

Please fill the following form, print it and fax it to 519 942-1111.


* All fields are mandatory

ASSOCIATE INFORMATION

Associate:
Ext.:
Department:
Plant:

VEHICLE INFORMATION

Make:
Model:
Vehicle identification
number (VIN) :
Year:
License plate number:
Service date:
Cone number:
Service needed:
8,000 km
16,000 km
24,000 km
32,000 km
3 months
6 months
9 months
12 months
Main minder:
1
2
3
4
5
6
Type A
Type B
Type C
Type D
Type E
Install all season tires
Install Winter tires
Tires are in trunk
Requires new tires
Windshield repair Body damage
What time is your car needed back?

Remarks:
Please fax to 519 942-1111
TERMS: STRICLY CASH UNLESS ARRANGEMENTS MADE
I hereby authorize the repair work herein set forth to be done along with the necessary parts and materials and agree that to the extent permitted by law, you are not responsible for loss or damage to vehicle or articles left in vehicle in case of fire, theft or any other cause beyond your control or for any delays caused by unavailability of parts or delays in parts shipments by the supplier or transformer. I hereby grant you and/or your employees permission to operate the vehicle herein described on streets, highways or elsewhere for the purposes of testing and/or inspection. Until payment in full of this invoice, I hereby acknowledge the existence of a repair lien in favour of this dealer on the vehicle described on this invoice in respect of the materials supplied and services rendered under this work order for the full amount invoiced. I further acknowledge that the said lien shall continue in force at all times, whether the vehicle is in my possession or possession of the dealer, until the repossession on demand by the dealer and until this account is paid in full.

We require the vehicle to have a half of a tank of gas in it. If we run out of gas or the gas light comes on there will be a fee of 10 dollars to stop and put gas in the car on top of the 15.00 of gas we put in the vehicle.
Is a written estimate required?
Yes No INITIALS ______
Are parts replaced to be kept for 48 hours?
Yes No INITIALS ______
DATE ____________ SIGNATURE ________________________________