Customer Information & Authorization

Please confirm your contact and vehicle information, describe the requested service, review the current CARTECH policies, and sign below.

1. Customer Information

Full Name

Phone

Email

Address

Year

Make

Model

VIN

License Plate

Mileage

Color

Customer Complaint / Requested Service

I have reviewed and agree to the company policies shown above.

I authorize CARTECH to operate and road test the vehicle when reasonably necessary.

I acknowledge the storage fee policy shown above.

I authorize the initial diagnostic amount shown above.

Printed Name

Date

Sign using your finger or mouse.

By submitting this form, you confirm that the information above is accurate and that you agree to the displayed CARTECH terms for this authorization.