Maintenance/Repair Form (Noncontracted Vendor)

Service Provider Name*

Service Provider Address*

Date Service(s) Provided*

If vehicle was serviced for multiple days, please select the date the vehicle was initially dropped off for maintenance/repairs.

UA Vehicle Number*

UA Vehicle Year, Make, & Model

Description of Service(s) Provided*

Was a safety inspection performed on the vehicle?*

Select or enter value

Attachments*

Please attach any documents provided by the service vendor, including itemized invoices and a safety inspection form (if one was completed).

Drag and drop files here or

Send me a copy of my responses