Battery Free Installation Customer Authorization Form

Customer authorization and waiver form for complimentary in-parking-lot battery installation, documenting vehicle eligibility, exclusion acknowledgment, and liability disclaimer for collateral electronics issues.

Customer Information

• Customer Full Name
• Phone Number
• Email Address (Optional)
  Provide your email if you would like a copy of this authorization sent to you.
• Date of Service
• Store Location / Branch

Vehicle Information

• Vehicle Year
• Vehicle Make
• Vehicle Model
• Trim / Sub-Model (Optional)
• License Plate Number
• Battery Location

Vehicle Eligibility & Exclusions

• I understand that the free installation service does not apply to the following vehicle types
  Excluded: hybrid/electric vehicles (HEV, PHEV, BEV), vehicles with AGM/EFB batteries requiring dealer-level registration, vehicles with battery located in inaccessible areas, commercial trucks over 1-ton, and any vehicle where installation poses a safety risk.
• My vehicle is best described as
• Technician Eligibility Confirmation
  To be completed by the store technician before proceeding.

Liability Disclaimer & Waiver

• Collateral Electronics Disclaimer – I acknowledge and agree to the following
  Modern vehicles may contain sensitive electronics (ECU, TPMS, radio presets, power windows, etc.) that can be affected by battery disconnection. Our technician will take reasonable precautions, but we do not warrant against, and are not liable for, any collateral electronic issues arising from this installation.
• No Implied Warranty on Collateral Systems – I acknowledge and agree
  This complimentary installation service carries no express or implied warranty for damage to vehicle electronics, software, or systems beyond the battery itself. The battery product warranty (if applicable) is separate and governed by the manufacturer's terms.
• Parking Lot Service Conditions – I acknowledge and agree
• Are there any known pre-existing electrical or electronic issues with your vehicle?
• Describe Pre-Existing Issues

Customer Authorization & Signature

• Authorization Confirmation
  I authorize this store and its technician to install the selected battery in my vehicle. I confirm I am the vehicle owner or an authorized representative.
• Customer Signature
  Sign below to complete your authorization.
• Date Signed
• Technician Name / ID
• Technician Signature
  Technician confirms vehicle eligibility and customer consent obtained.