Automotive Electronics
11120 Watt Circle | San Antonio, TX 78233 | 210-379-1395
 
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Email *
Customer Name *
Your Business Name
Customer Phone Number *
Additional Phone Number
Mailing Address: *
Vehicle Make, Model, and Year & Problem with the Vehicle *
Authorization of Services-Diagnostics
Authorization of Services-Cluster Repair
Authorization of Services-Module Repair
Drop off date: *
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DD
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YYYY
Time
:
TERMS OF AGREEMENT
1. All Credit Card Charges are Non-Disputable
2. Payment Due Upon Receipt
3. Make All Checks Payable to: Automotive Electronics
4. Checks will not be accepted from a personal account
5.All requests for alterations of mileage are for the purpose of representation of the true and correct mileage of the vehicle that work is being done on or for. Customer asserts that mileage change requests are for that purpose only.
6. Automotive Electronics is not responsible for any personal items left in vehicle.  You are asked to remove anything of value from your vehicle prior to it being in our possession.
By initialing below, I authorize Automotive Electronics to perform requested services and I agree to the Terms Of Agreement section above. *
Thank you for your business!
A copy of your responses will be emailed to the address you provided.
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