Kirkwood Citgo - Drop Off Form for Auto Repair

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

AFTER HOURS DROP OFF FORM

Name
Street Address
City State Zip
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