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Run: Battery Free Installation Customer Authorization Form

A customer authorization form for complimentary in-parking-lot battery installation. It captures vehicle details, eligibility acknowledgments, and a liabilit...

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Customer Information

Customer Full Name (required)

Phone Number (required)

Email Address (Optional)

Provide your email if you would like a copy of this authorization sent to you.

Date of Service (required)

Store Location / Branch (required)

Vehicle Information

Vehicle Year (required)

Vehicle Make (required)

Vehicle Model (required)

Trim / Sub-Model (Optional)

License Plate Number

Battery Location (required)

Vehicle Eligibility & Exclusions

I understand that the free installation service does not apply to the following vehicle types (required)

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.

Yes No N/A

My vehicle is best described as (required)

Technician Eligibility Confirmation (required)

To be completed by the store technician before proceeding.

Liability Disclaimer & Waiver

Collateral Electronics Disclaimer – I acknowledge and agree to the following (required)

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.

Yes No N/A

No Implied Warranty on Collateral Systems – I acknowledge and agree (required)

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.

Yes No N/A

Parking Lot Service Conditions – I acknowledge and agree (required)

Yes No N/A

Are there any known pre-existing electrical or electronic issues with your vehicle? (required)

Describe Pre-Existing Issues

Customer Authorization & Signature

Authorization Confirmation (required)

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.

Yes No N/A

Customer Signature (required)

Sign below to complete your authorization.

Date Signed (required)

Technician Name / ID (required)

Technician Signature (required)

Technician confirms vehicle eligibility and customer consent obtained.

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