Keefe Automotive Work Request
Once you complete this form you will be contacted to schedule an appointment.
Email *
CUSTOMER:  Email *
CUSTOMER:  First Name and Last Name *
CUSTOMER:   Phone Number *
Are you an In-District Resident? *
Are you currently a student at Keefe *
Are you employed at Keefe? *
CUSTOMER:  Town, Street ,Zip *
Vehicle Year *
Vehicle Make and Model  (i.e Ford F150) *
License Plate Number  *
Vehicle VIN# (This is for looking up parts to match your vehicle) *
CUSTOMER:   Indicate the work you are requesting to be performed on your vehicle. *
Required
CUSTOMER: If "OTHER", describe work to be done and/or problem with vehicle.
CUSTOMER:  I hereby autherize the repair work, including the purchase of necassary materials, to be performed by Keefe Tech Automotive for the purpose of student training.  An express Mechanics Lein is acknowledged on the vehicle to secure the amount of repairs thereto.  The district may operate the vehicle for the purpose of testing, inspection, or delivery and will not be held responsible for loss or damage to vehicle or articles left in vehicle in case of fire, theft, accident or any cause beyond our control.  I understand the school district agrees to no schedule or completion, assumes no responsibility for work performed, and offers no schedule guarantees or warranties expressed or implied. *
CUSTOMER:  I understand payment is due in full to picking up job requested.*** *
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This form was created inside of Keefe Regional Technical School (South Middlesex Regional Vocational Technical School District).

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