Fil-Co

Valued Auto Care

Membership application

Valued Auto Care

← Exit · Plans · Full program ·

Send this application

Text or email the blank form to the customer. After they fill it, send the answers to Tim & Jordan the same way.

APPLICATION FOR MEMBERSHIP

MEMBERSHIP

109 Carr Ave, Franklin, TN 37064 · (615) 656-1214

Today’s date

Date of last detail on this vehicle

Applicant full name

Cell phone

Birthday

E-mail

Home address Choose your package

Turbo $64/mo 4 Cylinder Essential $74/mo 6 Cylinder Preferred $99/mo 12 Cylinder Elite $149/mo

Vehicle year

Make

Model

1) Which days work best?

Monday Tuesday Wednesday Thursday Friday

2) Best time

3) Priority area on the car

4) Mobile or in-shop? (shop saves 10%)

5) Additional cars for 5% off?

Car #2 year / make / model / plan

Car #3 year / make / model / plan

6) What part of detailing are you looking forward to?

7) Who referred you?

8) Special considerations or concerns

Billing. We do not type full card numbers on this page. Tim or Jordan will take the card by phone or in the shop.

Name on card (for the file)

Zip

Monthly amount

I agree to the monthly payment option (1st of each month). I agree to pay the year in full. I authorize Valued Auto Care LLC to charge the card on file until I cancel in writing.

I allow VAC to open and clean the glove box and center console. Contents come out only as needed and go back. I have read the Membership Program and agree to the terms.

For internal use only

ID number

Start date

Paid?

Gold or Platinum in last 3 months?

Existing client, new membership?