Greentree Tire and Auto
621 W. Woodbine, Kirkwood, MO  63122
(314) 822-0065

AFTER HOURS DROP OFF FORM
Name

Street Address

City State Zip

E-Mail Address

Home Phone  Work Phone

Cell Phone Pager

What is the best way to contact you tomorrow?

VEHICLE YEAR MAKE

MODEL

COLOR LICENSE PLATE NUMBER

MAINTENANCE SERVICES REQUESTED (Please check all that apply)

Missouri State Inspection
Tire Rotation
Lube, Oil & Filter Change
Spin Balance Tires		 Brake Fluid Flush
Coolant Flush
Power Steering Flush
Auto Trans Fluid Flush		 Air Conditioner Test
Tire Repair
Wheel Alignment
Other (explain)

PROBLEM AREAS TO CHECK (please describe the problem or call us in the morning to explain in detail)
 
I hereby authorize the above repair work to be done along with the necessary material, and hereby grant you and/or your employees permission to operate the car, truck, or vehicle herein described on streets, highways, or elsewhere for the purpose of testing and/or inspection.  An express mechanic's lien is hereby acknowledged on the above car, truck, or vehicle to secure the amount of repairs there to:

Authorized by: ___________________________________________________________

Date

Please place this completed form and your key in an envelope and place
in our NIGHT DROP BOX.  Thank you!   Greentree Tire and Auto Staff

 

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