At D & D Automotive, You Get the Auto Repair Done Right in Southern MD and Waldorf

11785 Holly Auto Center Lane • Waldorf, Maryland 20601

Phone: 301-374-9540 • Fax: 301-374-9542

Hours: Monday Friday: 8am - 6pm
Saturday: 8am - 2pm • Sunday by Appointment
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Appointment Drop Off Form
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For your convenience - When using our early morning or late evening drop-off service:

1. Complete the following information, and then PRINT and sign this form.
2. After PRINTing, please EMAIL the form by selecting the SEND button below.
3. When using our Early Bird or Night Owl drop off, please be sure to park in the assigned area (not in the driveway) and LOCK your vehicle.
4. Place your keys in the envelope provided at the shop along with a printed and signed copy of this form.

Please complete the following information so we can properly serve you:

*Name:
*Required
*Email:
*Required to send by Email
Call me with an estimate before any work is performed:
Yes
No
Submitted to request an appointment ONLY:
Yes
No
Desired Pick Up Time:
License Plate:
Mileage:
Make & Model of your Vehicle:
Year:
Color:
Address:
City, State and Zip Code:
    
Home Phone:
Business Phone:
Cell Phone:
Best method to reach you:
When would you like to
pick up your vehicle?
Use this check list to note what service you would like completed:

Change Oil, Filter and Lube  -   (Synthetic )
Alignment
Rotate Tires
Balance Wheels

Replace Tires   If ALL, do you want a new Spare as well? Yes No

Inspect Belts
Electrical (Please describe in box below)
Tune Up
Engine Diagnostics
Check Emission system
Inspect Brakes
Check Air Conditioning System
Check Heating System/Output
Check Exhaust System
Check Steering System
Check Anti-Freeze Protection
Flush Cooling System
Replace Wiper Blades
State Inspection Required
BG Power Steering Flush
BG Transmission Flush
BG Induction / Injector System Flush
BG Coolant System Flush
BG Brake System Flush
Other Services/Problem Description:
By printing and providing this form, I hereby authorize the above repair work to be done along with the necessary parts and labor, and agree that you are not responsible for loss or damage to the vehicle or articles left in the vehicle in case of fire, theft or any other cause beyond your control or for any delays caused by unavailability of parts or delays in parts shipments by the supplier or transporter. I hereby grant you and/or your employee’s permission to operate the vehicle herein described on streets, highways, or elsewhere for the purpose of testing and/or inspection. An express mechanic’s lien is hereby acknowledged on the above vehicle to secure the amount of repair thereto. I understand because of the Early Bird/Night Owl Service, I am unable to receive a copy of the service estimate while placing this order.
Please Sign Here________________________________  Date:______________________

Please Print BEFORE submitting by Email
To submit by Email, please enter the Security Code exactly as shown: