Fill and Sign the Vehicle Authorization Form

Agreement to Repair Motor Vehicle with Authorization for Lien and Sale on Nonpayment of Repair Charges Agreement made on the _____________ (date), between __________________ (Name of Garage Owner) of ______________________________________________ (street address, city, state, zip code), referred to herein as Garage Owner, and ____________________ (Name of Customer), of _____________________________ _________________ (street address, city, state, zip code), referred to herein as Customer. For and in consideration of the mutual covenants contained in this Agreement, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: 1. The undersigned Customer request that Garage Owner repair the following described motor vehicle (the Vehicle): A. Year, Make and Model: ____________________________________;B.Vehicle Identification Number: ________________________________;C. License/Tag Number: ______________________________________; 2. The repairs requested are as follows: ________________________________ ______________________________________________________________________ ________________________________________________ (description of repairs).3.Garage Owner intends to begin such repairs on or about ______________ (date) and complete said repairs on or about _______________ (date).4. The approximate charges for the repairs services requested will be $___________ for labor and $___________ for parts, and the undersigned Garage Owner will claim a lien on the Vehicle for the actual amount of those charges. Payment of said charges shall be due upon receipt by Customer of the invoice for said charges from Garage Owner. Garage Owner may keep possession of the Vehicle until said invoice is fully paid.5. Customer, as the owner of the Vehicle left for repair, is to pay all expenses incurred in the repairing of the Vehicle. If Customer fails to pay all charges for repairing the Vehicle upon receipt of the invoice from Garage Owner, Garage Owner shall have the right to claim a lien on the described item. If the amount owing to Garage Owner is not paid by Customer within _______ (number) days after Customer receives notice of Garage Owner’s intention to sell the Vehicle to pay for labor and materials, Garage Owner may sell the Vehicle at auction to the highest bidder. To the extent Garage Owner receives more for the Vehicle than the charges for labor and materials, including a service charge of $__________ for sending notice to Customer and for auctioning the Vehicle, Garage Owner shall send a check for the remainder of the money to Customer at the address shown above.6.The invalidity of any portion of this Agreement will not and shall not be deemed to affect the validity of any other provision. If any provision of this Agreement is held to be invalid, the parties agree that the remaining provisions shall be deemed to be in full force and effect as if they had been executed by both parties subsequent to the expungement of the invalid provision. 7.The failure of either party to this Agreement to insist upon the performance of any of the terms and conditions of this Agreement, or the waiver of any breach of any of the terms and conditions of this Agreement, shall not be construed as subsequently waiving any such terms and conditions, but the same shall continue and remain in full force and effect as if no such forbearance or waiver had occurred.8. This Agreement shall be governed by, construed, and enforced in accordance with the laws of the State of ______________.9. Unless provided herein to the contrary, any notice provided for or concerning this Agreement shall be in writing and shall be deemed sufficiently given when sent by certified or registered mail if sent to the respective address of each party as set forth at the beginning of this Agreement. 10. This Agreement shall constitute the entire agreement between the parties and any prior understanding or representation of any kind preceding the date of this Agreement shall not be binding upon either party except to the extent incorporated in this Agreement. 11. Any modification of this Agreement or additional obligation assumed by either party in connection with this Agreement shall be binding only if placed in writing and signed by each party or an authorized representative of each party.12.The rights of each party under this Agreement are personal to that party and may not be assigned or transferred to any other person, firm, corporation, or other entity without the prior, express, and written consent of the other party.13.The undersigned Customer hereby releases Garage Owner from any damages or costs resulting from any future failure of said repairs that result from ____________ __________________________________________________ (e.g., inherent design or manufacturing defect of Vehicle). In not event shall any damages or costs resulting from the failure of said repairs exceed the cost of said repairs.14.This Agreement may be executed in any number of counterparts, each of which shall be deemed to be an original, but all of which together shall constitute but one and the same instrument. WITNESS our signatures as of the day and date first above stated. __________________________ _________________________ (Printed Name of Garage Owner) (Printed Name of Customer) __________________________ _________________________(Signature of Garage Owner) (Signature of Customer)