Work Authorization

Customer Email *

Customer Phone *

Last 4 Digits of Card *

Cardholder Name (as shown on card) *

I, the undersigned, hereby authorize Alpha Roadside Service (“ARS”) and/or its approved vendors, contractors, or technicians to perform the repair work, roadside assistance, or towing services described in the written or verbal estimate provided by an ARS representative. This authorization includes any labor, parts, materials, diagnostics, or related service actions deemed reasonably necessary to complete the requested service.

I understand and agree to the following:

1. Vehicle Responsibility & Liability

ARS is not responsible for loss, theft, or damage to the vehicle or personal belongings left inside the vehicle caused by fire, theft, weather, road conditions, or any circumstance beyond ARS’s control.

I grant ARS personnel permission to operate or move my vehicle for diagnostic, repair, or inspection purposes.

2. Additional Repairs & Authorization

If further issues are identified during service that require additional labor or parts, ARS will contact me for authorization before proceeding.

Supplemental estimates are considered part of this work authorization once approval is given verbally, electronically, or in writing.

3. Customer-Initiated Cancellation or Repair Halt

If I discontinue or cancel repairs for any reason after work has begun:

I am responsible for all labor performed up to the cancellation time.

I am responsible for all non-returnable parts, or any vendor restocking fees incurred by ARS.

Any parts paid for but not installed may be retained by me.

Truck / Trailer Mobile Repair Rates

(2-hour minimum on-site charge applies)

• 6am–8pm: $389 minimum (first 2 hours)

• 8pm–6am: $489 minimum (first 2 hours)

Fees & Rates:

• Normal Callout: $189 (6am–8pm)

• After-Hours Callout: $189 (8pm–6am)

• Drive To/From: Hourly rate (varies by distance & weather)

• Normal Hourly Rate: $100/hr first 2 hours, then $150/hr

• After-Hours Rate: $150/hr for all hours

• Fuel Surcharge: $59.99–$79.99, location-dependent

Bus / RV Mobile Repair Rates

(2-hour minimum on-site charge applies)

• 6am–8pm: $489 minimum

• 8pm–6am: $489 minimum

Fees & Rates:

• Normal Callout: $189

• After-Hours Callout: $189

• Drive To/From: Hourly rate

• Normal Hourly Rate: $150/hr

• After-Hours Rate: $150/hr first 2 hours, then $175/hr

• Fuel Surcharge: $59.99–$79.99

Towing Rates

(Rates vary with distance, weather, vehicle size/condition. All towing billed port-to-port.)

• Cars: $95 hook-up + $4/mile

• Truck Only: $495/hr

• Truck & Trailer: $629/hr

• Bus/RV: $695/hr

• Service Call Fee: $75

• Cancellation Fee: 50%

By signing below, I authorize Alpha Roadside Service to charge the credit card listed for all services rendered, including callout fees, labor, parts, towing charges, fuel surcharges, and any applicable cancellation or restocking fees.

I acknowledge and agree that:

• All card transactions include a 5.0% convenience fee.

• This authorization is valid for a one-time charge for the full amount listed on the work order, supplemental estimate, or final invoice.

• I certify that I am an authorized user of the payment method provided.

Non-Dispute

I agree not to dispute, charge back, or contest this payment with my credit card issuer as long as the charges correspond to the services, fees, and terms described in this authorization form and/or in the provided estimate(s).

Disputes filed in contradiction of this agreement may result in:

• Administrative fees

• Collections processing

• Recovery of chargeback penalties

• Full legal enforcement of this authorization

By submitting this form, I acknowledge and agree to the following provisions:

• Not all vehicles can be fully repaired roadside; some may require shop service or towing.

• No guarantees or warranties are provided for roadside repairs due to environmental and safety limitations.

• No refunds will be issued for services completed.

• ARS may use third-party contractors or vendors to complete services.

• Payment must NOT be made directly to any technician.

• • If payment is made directly to a technician, ARS may assess a 50% management fee for handling the breakdown.

Cancellation Policy

• After the submission of this form:

  • A $250 cancellation fee + credit processing fee applies for repair Service.

  • I agree to pay a cancellation fee equal to 50% of the total towing amount.

  • Cancellation fees are non-refundable.

I acknowledge that ARS begins dispatching technicians and resources immediately upon signing, and therefore I am fully responsible for all charges outlined in this agreement.

I understand that once I sign and submit this agreement, the service request becomes non-cancelable.

Signature (Full Name) *

Date (MM/DD/YYYY) *

I agree to the Terms of Service *
Yes, I agree.