First Name *

Last Name *

Company Name *

DOT Number

Phone *

Email *

Address *

Street Address

City

State

Country

Postal Code

Vehicle year *

Make *

Model *

VIN Number *

Mileage *

Describe the Problem/Services Needed *

Describe what's happening with the vehicle, any noises, leaks, warning lights, when it started, etc

Is the vehicle drivable? *

Was the vehicle towed? *

Upload photos or video of the issue

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 10 Files )

Upload Driver's License *

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 4 Files )

Upload additional Photos (optional)

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Repair & Storage Policy

Mechanic’s Lien & Theft of Services Notice

Authorization *

I have read and agree to the Repair & Storage Policy and the Mechanic’s Lien & Theft of Services Notice above.

I authorize Vinny Diesel Repair to perform diagnostics, repairs, towing, or related services on my vehicle

I understand the shop may require a diagnostics fee or parts deposit depending on findings.

I acknowledge the shop maintains a mechanic’s lien under Georgia law and may hold the vehicle until all charges are paid.

I agree to retrieve my vehicle within 48 hours after completion or declined estimate.

I understand storage fees of $55/day begin on the 3rd day after notification.

I understand unclaimed vehicles beyond 7 days past pickup deadline are considered abandoned under O.C.G.A. § 40-11

I understand the shop may send certified notices and pursue lien foreclosure and sale if required.

I authorize Vinny Diesel Repair and/or MCM Global Services to process payment once I approve the repair or parts order. if paid by credit or debit card it will appear on statement as MCM Global Services.

Preferred Payment Method *

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

Customer Signature *

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Date *

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