SULLIVAN'S AUTO &TRUCK REPAIR DBA SULLIVAN'S MOBILE...
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a:: UJ c a:: o a:: ~ UJ a:: PARTS CODE (CD): N-NEW U-USED R-REBUILT RC-RECONDITIONED FW-FREE UNDER WARRANTY RW-REDUCED COST UNDER WARRAN1Y .--~-~.---- SULLIVAN'S AUTO & TRUCK REPAIR DBA SULLIVAN'S MOBILE REPAIR MV52897 318 SOUTH MAIN STREET, BUSHNELL, FL 33513 352-569-9300 • 352-303-0978 Apt. No. Estimate/Diagnostic Fee: lor Hourly at $ A.M. PM. Per Hour o Check 0 Credit Card o Charge () 1-----+--1--------+------1----+-----+----1 o BROUGHT FORWARD TOTAL PARTS SIGNEDX DATE _ Actual Amount Estimated Amount SAVE REPLACED PARTS DYES PLEASE READ CAREFULLY, CHECK ONE OF THE STATEMENTS BELOW, AND SIGN: I UNDERSTAND THAT UNDER STATE LAW, I AM ENTITLED TO A WRITTEN ESTIMATE, IF MY FINAL BILL WILL EXCEED $100. D I REQUEST A WRITTEN ESTIMATE. D 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 WRITIEN OR ORAL APPROVAL. D I DO NOT REQUEST A WRITTEN ESTIMATE. DNO Estimated Cost of Repair Work Total labor We guaranteeour service work for days r-------~--+_~~~~~ or miles, whichever comes first. DAILY STORAGE CHARGES: *$ /DAY Repair Estimate Charges 'NO DAILY STORAGE CHARGES SHALL ACCRUE OR BE DUE AND PAYABLE f--'--------=--+--+--+--+---i FORA PER:OD OF 3 WORKING DAYS FROM THE DAY CUSTOMER IS NOTIFIED OF WORK COMPLETION. (E.g .. the State of Florida requires a $1.00 fee to be collected for each new tire sold in the state [s.403.718], and a $1.50 fee to be collected for each new or remanufactured battery sold in the state [5.403.7185]). This charge represents costs and profits to the 1--------+--+--+---+--1 motor vehicle repair facility for miscellaneous shop supplies or waste disposal. Total Parts IWAIVE REASSEMBLYOF MY VEHICLE INITIAL: I hereby authorize the repair work herein set forth to be done along with the necessary material and agree that you are not responsible for loss or damage to vehicle or articles left in vehicle in case of fire. theft or any other cause beyond your control or fa, any delays caused by unavailability of parts or delays in parts shipments by the supplier or transporter. I 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. Sub Total Tax Gas TOTAL AMOUNT x ~~~~~~~~------------- AUTHORIZED SIGNATURE
Transcript of SULLIVAN'S AUTO &TRUCK REPAIR DBA SULLIVAN'S MOBILE...
a::UJca::oa::~UJa::
PARTS CODE (CD): N-NEW U-USED R-REBUILT RC-RECONDITIONEDFW-FREE UNDER WARRANTY RW-REDUCED COST UNDER WARRAN1Y
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SULLIVAN'S AUTO & TRUCK REPAIRDBA SULLIVAN'S MOBILE REPAIR
MV52897318 SOUTH MAIN STREET, BUSHNELL, FL 33513
352-569-9300 • 352-303-0978
Apt. No.
Estimate/Diagnostic Fee:
lor Hourly at $
A.M.PM.
Per Hour
o Check 0 Credit Card o Charge
() 1-----+--1--------+------1----+-----+----1
oBROUGHT FORWARD
TOTAL PARTS
SIGNEDX DATE _
ActualAmount
EstimatedAmount
SAVE REPLACED PARTS DYESPLEASE READ CAREFULLY, CHECK ONE OF THESTATEMENTS BELOW, AND SIGN:I UNDERSTAND THAT UNDER STATE LAW, I AMENTITLED TO A WRITTEN ESTIMATE, IF MY FINALBILL WILL EXCEED $100.
D I REQUEST A WRITTEN ESTIMATE.
D I DO NOT REQUEST A WRITTEN ESTIMATE ASLONG AS THE REPAIR COSTS DO NOT EXCEED$ . THE SHOP MAY NOT EXCEEDTHIS AMOUNT WITHOUT MY WRITIEN OR ORALAPPROVAL.
D I DO NOT REQUEST A WRITTEN ESTIMATE.
DNO Estimated Cost ofRepair Work
Total laborWe guaranteeour service work for days r-------~--+_~~~~~or miles, whichever comes first.DAILY STORAGE CHARGES: *$ /DAY Repair Estimate Charges'NO DAILY STORAGE CHARGES SHALL ACCRUE OR BE DUE AND PAYABLE f--'--------=--+--+--+--+---iFORA PER:ODOF 3 WORKING DAYS FROMTHE DAY CUSTOMER IS NOTIFIEDOF WORK COMPLETION.(E.g .. the State of Florida requires a $1.00 fee to be collected for each new tire sold inthe state [s.403.718], and a $1.50 fee to be collected for each new or remanufacturedbattery sold in the state [5.403.7185]). This charge represents costs and profits to the 1--------+--+--+---+--1motor vehicle repair facility for miscellaneous shop supplies or waste disposal.
Total Parts
IWAIVEREASSEMBLYOF MY VEHICLE INITIAL:
I hereby authorize the repair work herein set forth to be done along with the necessarymaterial and agree that you are not responsible for loss or damage to vehicle orarticles left in vehicle in case of fire. theft or any other cause beyond your controlor fa, any delays caused by unavailability of parts or delays in parts shipments by thesupplier or transporter. I hereby grant you and/or your employees permission to operate thevehicle herein described on streets. highways or elsewhere for the purpose of testingand/or inspection.
Sub Total
Tax
Gas
TOTAL AMOUNTx ~~~~~~~~-------------AUTHORIZED SIGNATURE
. I
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Were 1rere krf 5gls of an InjJIy? Yes No If So, Desaibe BriefIy __
WTNESS STAlENENT
Name of InjuredAsrodate _
Dale of .Aai:lent to -lS -In
~ L~J,_t_·~
Dale
Figure 9-6 WMP-82 Witness Statement (page 2)
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WIlNESS STATEMENT
NaiTieCif IflJUrea ASSOaa1e -------------------------Dale of Aai:lent t 0- f ~ -r ()
i.dWrtress' Name--~~------~--~~----------
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l£lva ®f\Arncj) 'rt+IS fv~<S1...(CtfV(~_Were lhere Any Signs of an Injury? Yes NoL If So, Describe Briefly
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Figure 9-6 WMP-82 Witness Statement (page 2)
