Headlight Restoration Permission Slip

Customer Name: Phone Number: Vehicle Make & Model: License Plate: Date of Service: Location:

I authorize the technician to perform headlight restoration on my vehicle. I acknowledge that:

• This service is intended to improve clarity of headlights by removing surface oxidation and haze.
• Results may vary based on the condition of the headlights.
• The technician and service provider are not responsible for pre-existing damage to the headlights or surrounding areas.
• I release the service provider from liability for issues arising from this restoration.

By signing below, I give my consent for the headlight restoration service to be performed on my vehicle.