Modern Classics D.C.Take In Sheet
Please fill out all required fields. Insurance information is only required in the event of crash or theft repair and an insurance claim is being processed.
Owner Information
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Owner Name *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
E-Mail Address *
Your answer
Best Phone Number *
Your answer
Alternate Phone Number
Your answer
Insurance Information
Only necessary if making an insurance claim.
Insurance Company: Policy Number
e.g. State Farm: 012-3456789
Your answer
Insurance Contact Name: Phone
e.g. Joe Smith: 202-xxx-xxxx
Your answer
Insurance Claim Number
Your answer
Vehicle Information
Vehicle Year, Make, Model, Color *
e.g. 2006 Vespa LX150 Red
Your answer
Vehicle Tag Number
Your answer
Odometer Reading
Your answer
Service Information *
What work would you like us to perform? (Please note that if your vehicle is not registered, if legally required, we will not conduct a road test.)
Your answer
Would you like any replaced parts returned to you? *
Required
Upon completion of the work we will contact you. You have 3 days to arrange a pick-up date and settle the balance of your invoice before a $25/day storage fee is imposed. Bikes not claimed within 30 days of notice of completion become the property of Modern Classics. By checking the box below I agree that I have read all the above and filled out all required questions. I understand that Modern Classics has a labor rate of $95/hour. I understand that certain services may incur a flat fee charge. I agree to pay Modern Classics a minimum charge of one hour for the vehicle listed above. Please note, that if your vehicle is not registered, if legally required, we will not conduct a road test. *
Required
In addition, please type your name in the box below in acceptance of these terms and conditions as your digital signature. *
Your answer
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