D and B TOWING AND TRUCK SERVICE

D&B TOWING AND TRUCK SERVICE

Work Release Form

Authorization to Repair

I give D&B Towing and Truck Service, Inc., located in Hazle Township, PA, authorization to complete services of repair to my personal/business vehicle/equipment. D&B Towing has informed me of the necessary repairs needed and I am in agreement of all charges that apply to such labor services including parts and materials.

I understand and agree with D&B Towing that throughout the repair process, additional repairs, along with parts and materials may be required to complete repairs. If such does occur, D&B Towing will inform me of the additional necessary repairs and cost if available, and I agree to pay all charges that may apply.

Company*

Date*

Authorized by (Name)*

Position*

Phone Number*

Fax Number*


Vehicle Information

Year*

Make*

Model*

VIN Number (last 8)*

Vehicle/Equipment Number*


Diagnosed Repairs Needed

Parts Needed

Max Repair Amount ($)*


Payment Terms

Credit cards and company checks are not accepted for invoices over $1,000.00. All non-present credit cards require written authorization. We accept Cash, Comchek, EFS, T-Chek, and Certified Bank Checks for invoices over $1,000.00.

Payment is due upon completion on job.

Your Email Address*

Signature (Type Name)*

Date*

PLEASE READ CAREFULLY

Charges may apply for time and materials needed while completing an estimate for repairs needed.

D&B Towing’s warranty on all repairs/parts are an EXCHANGE POLICY ONLY. NO CASH/CREDIT REFUNDS. WARRANTY ON ALL PARTS/SERVICE VOIDS AFTER 30 DAYS FROM SERVICE DATE. ALL PARTS MUST BE RETURNED IN ORDER TO RECEIVE WARRANTY. NO PARTS-NO WARRANTY

THANK YOU FOR YOUR CONTINUED BUSINESS.

I understand and agree with the payment options and terms that are described in this form.*
I agree.

(*) Indicates a required field.

Authorization to Repair

I give D&B Towing and Truck Service, Inc., located in Hazle Township, PA, authorization to complete services of repair to my personal/business vehicle/equipment. D&B Towing has informed me of the necessary repairs needed and I am in agreement of all charges that apply to such labor services including parts and materials.

I understand and agree with D&B Towing that throughout the repair process, additional repairs, along with parts and materials may be required to complete repairs. If such does occur, D&B Towing will inform me of the additional necessary repairs and cost if available, and I agree to pay all charges that may apply.

Company*

Date*

Authorized by (Name)*

Position*

Phone Number*

Fax Number*


Vehicle Information

Year*

Make*

Model*

VIN Number (last 8)*

Vehicle/Equipment Number*

Diagnosed Repairs Needed

Parts Needed

Max Repair Amount ($)*


Payment Terms

Credit cards and company checks are not accepted for invoices over $1,000.00. All non-present credit cards require written authorization. We accept Cash, Comchek, EFS, T-Chek, and Certified Bank Checks for invoices over $1,000.00.

Payment is due upon completion on job.

Your Email Address*

Signature (Type Name)*

Date*

PLEASE READ CAREFULLY

Charges may apply for time and materials needed while completing an estimate for repairs needed.

D&B Towing’s warranty on all repairs/parts are an EXCHANGE POLICY ONLY. NO CASH/CREDIT REFUNDS. WARRANTY ON ALL PARTS/SERVICE VOIDS AFTER 30 DAYS FROM SERVICE DATE. ALL PARTS MUST BE RETURNED IN ORDER TO RECEIVE WARRANTY. NO PARTS-NO WARRANTY

THANK YOU FOR YOUR CONTINUED BUSINESS.

I understand and agree with the payment options and terms that are described in this form.*
I agree.

(*) Indicates a required field.