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Work Request

Shop rate - $100/hour

Custom work is billed at the time it takes to complete

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Your Information ^*

First Name ^*

Last Name ^*

Email ^*

Phone Number ^*

Company

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Can we text the number provided? ^*

Yes

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Please enter your complete address ^*

Address ^*

Address line 2

City ^*

Province

PC ^*

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Year, make & model of vehicle ^*

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Work requested for vehicle: ^*

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Any additional info?

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If you have a BUDGET, please add it here. If we get close to your budget, we will call to discuss any additional work required. We will not use poor quality parts to fit your budget.

If you don't have a specific budget, you can leave blank.

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I understand that Cycle Clinic is CASH ONLY. This does not include debit or e-transfers.  ^*

Initial below to indicate understanding

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Due to limited space, you are expected to pick up your vehicle within 48 hours of it being competed, unless otherwise arranged. If your vehicle is left for longer than 48 hours, you will be charged $40/day until picked up.  ^*

Initial below to indicate understanding

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I hereby authorize the above requested repair work to be done along with the necessary materials to complete the work. Cycle Clinic and it's employees may operate the above vehicle for the purpose of testing, inspection, or other work requested at my own risk. It is understood that Cycle Clinic will not be held responsible for the loss or damage to the vehicle or articles left in the vehicle in the case of fire, theft, or other cause beyond control of Cycle Clinic. ^*

Please sign below, ensure Cycle Clinic has your keys.

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