MOTOR VEHICLE REPAIR AUTHORIZATIONINEPENDENT, LLC 5334 Marinelli Road North Bethesda, MD 20852 Montgomery County Reg. No. 15-MT-001932 Name * First Name Last Name Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Description of Problem or Service Requested * You are entitled to a written estimate upon request if repairs will exceed $25.00. Do you want a written estimate? * Yes No You are entitled to the return of any replaced parts except those that must be returned to the manufacturer under a warranty agreement (Core fees may apply). Do you want your old parts? Yes No How did you hear about us? * Google Facebook Instagram Friend Yelp Driving by Other You may not be charged an amount more than 10% above an estimate without your consent. * I understand Repairs not originally authorized by you will not be charged without your consent. * I understand Independent employees may operate the vehicle for purposes of testing, inspection, or delivery. * I understand Federal law requires manufacturers to furnish the National Highway Traffic Safety Administration (N.H.T.S.A.) with bulletins describing any defects in their vehicles. You may obtain copies of these bulletins either from the manufacturer or N.H.T.S.A. In addition, certain consumer publications or organizations publish this information, which may be available for a fee or for free. * I understand INDEPENDENT, LLC is not responsible for any damage to your vehicle or theft of items left in your vehicle. Please remove any valuables from your vehicle. If your vehicle is not picked up within 24 hours of notification of completion, a $35.00 storage fee will be charged each day thereafter. INDEPENDENT is NOT open on Saturday or Sunday. We can arrange for afterhours pick-up. * I understand Date MM DD YYYY Thank you! We’re excited to keep your Land Rover rolling.
