Business Printing 2026 YOUR COMPANY NAME HERE 123 MAIN STREET YOUR TOWN, STATE AND ZIP (123) 465-7250
I
YOUR FINANCIAL INSTITUTION CITY, STATE and ZIP
YOUR COMPANY NAME HERE 123 MAIN STREET YOUR TOWN, STATE AND ZIP
YOUR FINANCIAL INSTITUTION CITY, STATE and ZIP 00-6789-0000
Security features. Details on back.
00-6789-0000
DOLLARS
YOUR COMPANY NAME HERE MEMO
123 MAIN STREET YOUR TOWN, STATE AND ZIP (123) 465-7250
AUTHORIZED SIGNATURE
YOUR FINANCIAL INSTITUTION CITY, STATE and ZIP 00-6789-0000
001001 000067894 12345678 I
REPAIR ORDER
123 MAIN STREET YOUR TOWN, STATE AND ZIP
00-6789-0000
DATE
Security features. Details on back.
YOUR FINANCIAL INSTITUTION CITY, STATE and ZIP
YOUR COMPANY NAME HERE
DOLLARS
HOME # CELL #
STATE
ZIP
WORK #
YOUR COMPANY NAME HERE
INTENDED PAYMENT METHOD
£ CASH
£ CHECK
£ VISA £ MC £ DISCOVER
£ AMEX £ OTHER __________________
VEHICLE I. D. NO.
£ Brakes
ENGINE SIZE
£ A/C £ Tune-Up
CYLINDERS
£4
DATE
001002 000067894 12345678
ADDRESS CITY
COLOR
£ Oil Change
AUTHORIZED SIGNATURE
MILEAGE YR. & MAKE MODEL
123 MAIN STREET • SWANTON, VT 05488 555.555.1234 • www.AutoMedics.com
TECHNICIAN
SERVICE REQUEST £ Muffler MEMO
NAME
£6
£ Alignment £ Shocks/Struts
£ Tires £ Other
ODOMETER IN
QTY
DESCRIPTION / PART NO.
PARTS
LABOR
DRIVE
£8
£ FWD
£ RWD
£ 4WD
BRAKES
TRANSMISSION
£ AUTOMATIC
£ ABS
£ MANUAL
£ NON-ABS
REPAIR INSTRUCTIONS (Customer States) I
YOUR FINANCIAL INSTITUTION CITY, STATE and ZIP
123 MAIN STREET YOUR TOWN, STATE AND ZIP
JOB NUMBER
00-6789-0000
RECOMMENDATIONS Security features. Details on back.
YOUR COMPANY NAME HERE
DOLLARS
PLEASE READ CAREFULLY. Check one of the statements below and sign. I understand that under state law, I am entitled to a written estimate if my final bill exceeds $100.00.
£ I request a written estimate. £ I do not request a written estimate as long as the repair cost does not exceed $ . The shop may not exceed this amount without my approval. £ I do not request a written estimate.
AUTHORIZED SIGNATURE
001003 000067894 12345678
SIGNATURE
JOB NAME
DATE
A DAILY STORAGE FEE OF $20.00 will be charged if the vehicle is not picked up within 48 hours after being notified that the work has been completed.
MOTOR OIL / FILTER
£ ENVIRONMENTAL FEE
ANTIFREEZE
LABOR
AUTHORIZED BY CALLED BY
LABOR
DESCRIPTION OF ADDITIONAL WORK AUTHORIZED £ IN PERSON £ BY PHONE PHONE
TOTAL DATE
PLEASE MAKE ALL CHECKS PAYABLE TO:
AUTO MEDICS
:
3/($6( 5( (17(5 727$/ +(5(
'(326,76 0$< 127 %( $9$,/$%/( )25 ,00(',$7( :,7+'5$:$/
▲
▲
<285 %86,1(66 1$0( +(5( <285 675((7 $''5(66 <285 &,7< 67$7( $1' =,3
001001 000067894 12345678 &+(&.6 $1' 27+(5 ,7(06 $5( 5(&(,9(' )25 '(326,7 68%-(&7 72 7+( 3529,6,216 2) 7+( 81,)250 &200(5&,$/ &2'( 25 $1< $33/,&$%/( &2//(&7,21 $*5((0(17
1001
For the amount of
1001
YOUR COMPANY NAME HERE 123 MAIN STREET YOUR TOWN, STATE AND ZIP (123) 456-7890
Issued to Compliments of
Date
Issued to Compliments of
Date Authorized signature
Exp. Date Exp. Date
Gift Certificate
$
For the amount of Authorized signature
Gift Certificate
Bello dei Tesori 3314 Swan Way Lake Pennington, NY, 66226 www.bellodeitesori.com
Isabelle Felleti Owner, Buyer
321.555.8765 isabella.felleti@bellodeitesori.com
DP535 PCJ26C30
PRICES EFFECTIVE FEBRUARY 2, 2026
PARTS DISCOUNTS
TIME
AM PM
TAX
PLEASE PAY THIS AMOUNT
3/($6( %( 685( $// ,7(06 $5( 3523(5/< (1'256('
7 2 7 $ /
$
FUEL
REVISED ESTIMATE / ADDITIONAL WORK PARTS
SAVE OLD PARTS
£ YES £ NO
w
;
;
;
;
SIGNATURE
727$/ &+(&.6
;
The shop is not responsible for any personal items left in vehicle.
00-6789/0000
;
;
&2,1
&+(&.6 ,1&/8'( $'' 7$3(
&855(1&<
727$/ &855(1&<
727$/ &$6+
'$7(
'(/8;(
'(326,7 7,&.(7
YOUR FINANCIAL INSTITUTION CITY, STATE AND ZIP
)25 &/($5 &23< 35(66 ),50/< :,7+ %$// 32,17 3(1
DATE
I hereby authorize the above repair work to be done along with the necessary materials. You and your employees may operate vehicle for purposes of testing, inspection, or delivery at my risk. An express mechanics lien is acknowledged on above vehicle to secure the amount of repairs thereto. It is understood that you will not be held responsible for loss or damage to vehicle or articles left in vehicle in case of fire, theft or any other cause beyond your control. In the event it becomes necessary to collect all or a portion of this work order, then Auto Medics shall be entitled to recover court costs, interest and attorney's fees. “This charge represents costs & profits to the motor vehicle repair facility for miscellaneous shop supplies or waste disposal.” [S.559.904(4)]
TIRE
TOTAL
123 MAIN STREET YOUR TOWN, STATE AND ZIP (123) 465-7250
YOUR FINANCIAL INSTITUTION CITY, STATE and ZIP 00-6789-0000