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SERVICE REPAIR ORDER REQUEST - COGGIN TOYOTA at the AVENUES

VIN #

10564 P h ili ps H igh w ay, Jac k s onvi lle F L 32256- 1 . 9 0 4 .2 6 2 .0 3 3 8

DATE

PROMISE DATE

NAME:

YEAR - MAKE - MODEL

TAG #

TELEPHONE #’s

ADDRESS:

#

HOME

(MV#02423)

APPOINTMENT

MILES

WAIT

SHUTTLE

WORK

RENTAL

TODAY

READY BY

CELL/PAGER

METHOD OF PAYMENT CASH

CONCERN

CREDIT CARD CHECK

PRIORITY #

(PRIOR APPROVAL)

OTHER

CONCERN

DISPOSAL FEES

BATTERY, ea $ 1.50

PRIORITY #

(s.403.7185)

TIRES, ea

(s.403.718)

MISCELLANEOUS SHOP SUPPLIES AND/OR WASTE DISPOSAL CHARGE

CONCERN

[s.559.904(4)]

PRIORITY #

THIS CHARGE REPRESENTS COSTS AND PROFITS TO THE MOTOR VEHICLE REPAIR FACILITY FOR MISCELLANEOUS SHOP SUPPLIES OR WASTE DISPOSAL.

CONCERN PRIORITY

#

ALL PARTS ARE NEW UNLESS OTHERWISE INDICATED

CONCERN PRIORITY

REPLACED PARTS REQUESTED

YES

NO

SEE REPAIR ORDER FOR ALL TERMS AND CONDITIONS AND SIGNATURES LABOR CHARGES ARE BASED ON A FLAT RATE PER HOUR. THE HOURS ARE PUBLISHED IN A FLAT RATE MANUAL WHICH REFLECTS AN AVERAGE TIME REQUIRED FOR THE PERFORMANCE OF SPECIFIC VEHICLE REPAIRS, AND WHICH MAY, THEREFORE, BE EITHER MORE OR LESS THAN THE ACTUAL CLOCK TIME IN ANY GIVEN INSTANCE. STORAGE CHARGES: No storage charges will accrue or be due and payable 3 working days from the date you are notified that the work on your vehicle has been completed. After that date, the daily charge for storage of your vehicle will be $15.00.

NOTE: Estimate amounts are based on initial inspection only. Additional parts and labor may be required. You will be notified upon completion of any diagnostic work necessary to estimate the cost of repair, or if the actual charges will exceed the written estimate, including any additional authorized charges, by $10 or 10%, whichever is greater, not to exceed $100.00. If you are so notified, you may orally or in writing authorize, modify or cancel the order for repair.

PARTS AND LABOR ARE GUARANTEED FOR 12 MONTHS UNLIMITED MILES.

LIMITED WARRANTY: The only warranties applying to the part(s) in accordance with this estimate are those that may be offered by the manufacturer. The seller hereby expressly disclaims all warranties, either express or implied, including any implied warranty of merchantability or fitness for a particular purpose, and neither assumes not authorizes any other person to assume for it any liability in connection with the sale of products or services sold under the terms of this estimate. Seller does not guarantee the work performed in accordance with this estimate will correct any problem specified on the description of the complaint.

I understand that all parts and accessories sold or used are subject to the Federal MagnussionMoss Act and the consumer merchandise purchased is under LIMITED WARRANTY by the manufacturer and the written terms and conditions thereof are available for my inspection.

not responsible for the loss or damage to vehicle or articles left in vehicle in case of fire, theft or any other cause beyond your control (PLEASE REMOVE ALL PERSONAL BELONGINGS FROM VEHICLE) or for any delays caused by unavailability of parts or delays in parts shipment by the supplier or transporter. I

I hereby authorize the repair work herein set forth to be done along with the necessary material and agree that you are

hereby grant you and/or your employees permission to operate the vehicle herein described on streets, highways or elsewhere for the purpose of testing and/or inspection. An express mechanicʼs lien is hereby acknowledged on above vehicle to secure the amount of repairs thereto. Not responsible for damage from freezing due to lack of antifreeze. Customer Signature X

$ 1.00

___________________________________________

_____________ .

M I NI MU M D I A GNO STI C & ESTI M A TE F EE - $ 4 2 .5 0

ORIGINAL ESTIMATE $

DATE

TIME

BY

ADDITIONAL DATE TIME BY AUTHORIZED AMOUNT $ REVISED DATE TIME BY AUTHORIZED ESTIMATE $ NAME AND PHONE NUMBER OF OTHER PERSON WHO MAY AUTHORIZE ADD’L REPAIRS

PLEASE R EAD CAR EFULLY, CHECK ONE OF THE ST AT EM ENTS BELOW A ND S IGN: I U NDER S TAND THAT UNDER STA TE LAW, I A M ENT ITLE D T O A WRIT TEN ESTIMA TE, IF MY FI NAL BILL WILL EXCEED $10 0.0 0.

_______ I REQUEST A WRITTEN ESTIMATE. _______ I DO NOT REQUEST A WRITTEN ESTIMATE AS LONG AS THE REPAIR COSTS DO NOT EXCEED $_________________. THE SHOP MAY NOT EXCEED THIS AMOUNT WITHOUT MY WRITTEN OR ORAL APPROVAL. ________I DO NOT REQUEST A WRITTEN ESTIMATE.

SI GNED : X _ __ _ __ _ __ _ __ _ __ _ __ _ DA TE: _ __ _ __ .

© Copyright 2007 Bob Witham’s Automotive Service Marketing Systems, P.O. Box 1557, St. Augustine, FL 32085 1.904.940.0006


SERVICE REPAIR ORDER REQUEST - COGGIN TOYOTA at the AVENUES 10564 P h ili ps H igh w ay, Jac k s onvi lle F L 32256- 1 . 9 0 4 .2 6 2 .0 3 3 8

EXPRESS SERVICES

Basic:

Silver: Gold:

Oil & Filter Change, 19-point Inspection

$

24.95

Plus 2 Wiper Blades

$

39.95

Oil & Filter Change, 19-point Inspection, ............................

Oil & Filter Change, Plus 1 Air Filter ....

$

39.95

Plus 2 Wiper Blades

$

59.95

Platinum: Oil & Filter Change, Plus 1 Air Filter,

............................

Tire Rotate & Balance, 4 wheel ................................

$

Brake Job, front (Pad replacement)

$ 109.95

Wheel Alignment, 4 wheel ....................................... ................................

Brake Service, Rear (Clean & adjust) ..............................

Automatic Transmission Service

.........................

Automatic Transmission Service, Type 4

Manual Transmission Service

Differential Service

.............

.............................

.............................................

A/C Refresher Service

.........................................

Fuel Induction Service .........................................

Cooling System Service ........................................

Battery Replacement

...........................................

ADDITIONAL SERVICES Timing Belt Replacements

34.95

$

69.95

$

39.95

$

69.95

$

39.95

$

69.95

$

$

$

$

$

59.95

39.95 59.95

49.95

69.95

.......................... 4 Cyl

$ 219.95

8 Cyl

$ 349.95

6 Cyl

(MV#02423)

$ 259.95

MOC SERVICES

Automatic Transmission Flush

See your Service Advisor for Details

............................................

Automatic Transmission Flush, Type 4 .................................

Renewable to a Maximum 8 Year/120,000 Mile Gold Medal Limited Warranty See your Service Advisor for Details

Power Steering Flush ...........................................................

Cooling System Flush ...........................................................

Brake Fluid Flush

Battery Service

................................................................

....................................................................

$129.95

$149.95

$109.95

$ 89.95

$ 99.95

$ 19.95

© Copyright 2007 Bob Witham’s Automotive Service Marketing Systems, P.O. Box 1557, St. Augustine, FL 32085 1.904.940.0006

SERVICE RO REQUEST FORM  

8.5 x 11.0" customer write-up form 2 sides

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