Authorization to Release Vehicle
10646 Goodnight Ln
Dallas, TX 75220
(469) 325-8201
www.dallasfamilydent.com

Vehicle Release Form

Authorizes pickup of the vehicle described below and acknowledges the terms of release.

Service Representative
Owner
*
Vehicle
*
*
*
*

I give Dallas Family Dent authorization to pick up my above-mentioned vehicle and acknowledge that a) Dallas Family Dent is not responsible or liable for any preexisting mechanical issues with my vehicle; furthermore, I understand I must disclose any preexisting mechanical issues with Dallas Family Dent before releasing my vehicle. b) Dallas Family Dent is not responsible or liable for any mechanical issues that incur while my vehicle is being worked on, stored, or transported, and c) Dallas Family Dent is not responsible or liable for any items left in my vehicle.

Sign here
Owner Signature
Date
Date
Dallas Family Dent — Vehicle Release FormPage 1 of 1