Damage Waiver – Citywide Automotive

Please fill out the form below to request service.

Damage Waiver Form

Please complete the following form....

Name

First

Last

Consent

City Wide Automotive Corp appreciates your business; if you have any questions regarding this invoice, please contact us at 845-603-6900. Thank you. Damage Disclaimer: I Have been advised that my vehicle may be damaged if winched, towed, unlocked, jump-started, tire changed, or left on unattended premises. I recognize the difficulty involved and I agree not to hold City Wide Automotive Corp responsible for such damages should it result. I, the undersigned, do hereby certify that I am legally authorized and entitled to take possession of the vehicle described and all personal property therein. I have received the vehicle and all personal property in satisfactory condition. Credit Card Disclaimer: By signing the invoice/form above, you authorize City Wide Automotive Corp. to debit your credit card for the amount above and credit card fees. Signing the above form makes you responsible for all charges! If you dispute this charge, you will pay all applicable fees that may be charged to our company! All information on the Credit or Debit card is provided above.

Signature

Clear Signature