Best Rate Fleet Services - Customer Authorization

1. CUSTOMER & JOB INFORMATION

Customer / Company *

Phone / Email *

Unit / VIN / Plate

Work Order / Invoice *

Amount Charged *

Card Last 4 Digits *

Service Location Written Exceptions / Unfinished Items *

NONE Exceptions

2. CUSTOMER AUTHORIZATION & ACCEPTANCE

By signing below, I certify and agree that I requested, approved, received, and accept the services, labor, diagnostics, parts, towing/recovery, mileage, call-out, wait time, storage, taxes, and other itemized charges shown on the related work order or invoice. I have inspected the work or had a reasonable opportunity to do so, and the work and service are satisfactory and complete for the authorized scope, except only for written exceptions stated above. I authorize Best Rate Fleet Services to collect the amount shown above using the payment method separately provided through its approved payment processor. I understand that diagnostic conclusions, temporary repairs, customer-declined recommendations, pre-existing conditions, and work outside the authorized scope are not promises that the vehicle/equipment is free of all defects. I will promptly contact Best Rate Fleet Services to allow a good-faith investigation of any claimed billing or service error. Nothing in this form waives any right that cannot lawfully be waived.

I have read and agree to the authorization above and intend my signature below to serve as my electronic signature. *

3. CUSTOMER FINGER SIGNATURE

Printed Name *

Driver / Representative

Date / Time

Sign with your finger below *

Use your finger or stylus to sign inside the box.

ONLY THE LAST 4 DIGITS OF THE CARD ARE RECORDED ON THIS FORM.
Do not enter the full card number, expiration date, CVV/CVC/CID, PIN, or other card credentials anywhere on this form.

FINAL SERVICE ACCEPTANCE

Creating & Sending Authorization