Automotive Shop Repair Request

The type of work students conduct changes each quarter throughout the school year to match the material taught in the classroom and lab.

Please don't fill out this input box.

Owner Information

Name*

Home Phone

Work Phone

Address

Are you a CBC Employee?

Yes, I am a CBC Employee

No, I am not a CBC Employee

Vehicle Information

Make of car*

Model and Sub-Model**

Year*No vehicles older than 1996

License*

VIN*

Color*

Engine size

Repair

Estimate Needed*

Yes

Repair Cost Limit

Signature

I hereby release and hold harmless Columbia Basin College personnel and students of any liability in connection with the repair work performed on my vehicle. It is understood there is no guarantee or warranty on the work performed as it is part of the instructional program with the work being performed by students in that program. Also, I authorize my vehicle to be test driven by the instructor or a student that the instructor has authorized. I further understand that Columbia Basin College is in no way responsible for any type of damage to or theft of or loss of any item(s) from my vehicle. Any items of value should be removed from your vehicle prior to being left for repair.

I agree to pay the automotive repair bill upon completion of work requested.

Remember, please lock your vehicle.

E-Signature*Please type your full name

Email Address*

Date (mm/dd/yyyy)*

Automotive Shop Repair Request