ARIZONA TRUCK A/C & REPAIR, LLC

SERVICE REQUEST FORM

CUSTOMER INFORMATION

Business / Carrier Name *

Owner Name / Responsible Party *

NTP Warranty *

Yes

Phone *

Email *

Address

Business / Carrier Address *

City *

State *

Postal Code *

SECONDARY CONTACT

Secondary Contact Name

Secondary Contact Title

Secondary Contact Phone

Secondary Contact Email

HOW DID YOU HEAR ABOUT US?

How Did You Hear About Us

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SERVICE AGREEMENT & TERMS OF AUTHORIZATION

Warranty Disclaimer & Limitations

Any warranties on products sold are solely those of the manufacturer. Arizona Truck A/C & Repair, LLC does not assume liability beyond those warranties. Parts carry a one (1) year manufacturer warranty and a thirty (30) day labor warranty.

Authorization of Repairs

Customer authorizes Arizona Truck A/C & Repair, LLC to perform the repairs described. Additional repairs identified during inspection will require customer approval. The company is not responsible for delays due to parts availability or loss of personal property left in the vehicle.

Payment & Billing Terms

• Payment in full is required prior to vehicle release.

• Accepted payment methods: cash, debit card, Visa, Mastercard, Discover, and American Express.

• EFS checks, ACH payments, and paper checks are not accepted.

• All diagnostic services are subject to a two (2) hour minimum charge.

• Mobile call-out fees and diagnostics fees are due prior to dispatch.

• After-hours and weekend labor is billed at 1.5 times the standard rate.

• Balances not paid upon completion accrue a 10% weekly service charge.

Storage, Towing & Yard Policies

• A storage fee of $120.00 per day will be assessed 48 hours after repairs are completed.

• All towing charges must be paid directly to Arizona Truck A/C & Repair, LLC.

• Drivers and customers are prohibited from the gated yard unless escorted by staff.

• To ensure safety, Please ensure that all people and pets are out of the vehicle before service begins.

CONSENT & AGREEMENT

I authorize Arizona Truck A/C & Repair, LLC to charge the credit card listed for services, parts, diagnostics, mobile call-out fees, after-hours labor, storage fees, towing charges, and any other charges incurred in accordance with the Service Agreement & Terms of Authorization.

By signing I waive any right to dispute or reverse payment for authorized charges. In the event a chargeback is initiated, I agree such action constitutes a breach of this agreement and I agree to immediately remit payment for the disputed amount, including all processing fees, penalties, and reasonable costs incurred in collection.

I acknowledge that I have read, understand, and agree to all terms and conditions stated above. *

Agree