Client Drop-off Form

CLIENT DROP-OFF FORM

RECITALS

WHEREAS, Service Provider Name: operates a facility that inspects, services, stores and/or repairs client property; and

WHEREAS, Client Name: desires to deliver certain items to Service Provider for evaluation, repair, storage, or related services under the terms set forth below; and

NOW, THEREFORE, the parties agree as follows.

CLIENT INFORMATION

ITEM(S) DROPPED OFF

Item 1 — Description: Serial/ID:

Condition: Accessories included:

Declared value: Estimated initial inspection fee:

Item 2 — Description: Serial/ID:

Condition: Accessories included:

Declared value: Estimated initial inspection fee:

SCOPE OF WORK

Describe the services requested, inspection steps, and any special instructions. Service Provider will perform work only as authorized by Client or as necessary to render the items safe for handling.

PAYMENT TERMS

Estimated total amount: Deposit required at drop-off:

Balance due on pickup or completion unless otherwise agreed. Payment methods accepted: cash, card, or approved account. If Client does not pick up items within days after notice of completion, storage and additional fees may apply.

Late fee rate:

TERM AND TERMINATION

This agreement commences on and continues until unless earlier terminated as provided herein.

Either party may terminate upon written notice delivered days prior to the intended termination date. Termination does not relieve Client’s obligation to pay for services performed and storage accrued prior to termination.

CONFIDENTIALITY

Each party shall maintain in confidence all non-public information disclosed in connection with the items and services, and shall not disclose such information to third parties except as reasonably required to perform services, as compelled by law, or with the other party’s written consent. This obligation survives termination of this form for a period of two years.

LIABILITY, STORAGE & DISPOSITION

Service Provider will exercise reasonable care in possession of items but shall not be liable for loss or damage except to the extent caused by Provider’s gross negligence or willful misconduct. Client’s recovery for any claim shall be limited to repair or replacement costs not to exceed the declared value stated above per item.

Storage fees commence days after notice of completion and will accrue at thereafter. If items remain unclaimed after days following final notice, Provider may dispose of items and apply proceeds against outstanding charges.

AUTHORIZATION & CONSENTS

Client hereby represents that Client is the lawful owner or authorized agent of the items dropped off and has full authority to enter into this agreement. Client authorizes Provider to perform diagnostics and the Scope of Work described above. Client authorizes Provider to order necessary parts and to incur expenses up to without additional consent. Provider will attempt to contact Client before exceeding that amount.

Authorized pickup by a third party (if applicable): Name: Relation/ID to be presented:

GOVERNING LAW; ENTIRE AGREEMENT

This form is governed by the laws of the state of without regard to conflict of law principles. This document, together with any written estimates or authorizations referenced herein, constitutes the entire agreement between Client and Service Provider regarding the items and supersedes all prior discussions and representations.

CLIENT ACKNOWLEDGMENT

By signing below, Client acknowledges delivery of the items listed above, agrees to the Scope of Work, Payment Terms, Liability, Storage & Disposition provisions, and authorizes Provider to act as described. Client certifies that all information provided on this form is true and accurate.

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