Authorization to Repair and Receive Payment

WE DO NOT ACCEPT PERSONAL CHECKS

We Gladly Accept Cash, Cashiers Check, Money Order, and Insurance Check

Credit/Debit Cards are accepted with an additional 3.3% + .40 cents per transaction.

Customer Name(Required)
Customer Address(Required)
By signing and submitting this form, you understand and agree that all electronic signatures are the legal equivalent of my manual/handwritten signature and I consent to be legally bound to this agreement.