New Customer Information/Payment Authorization Form

Remittance of this form is required to secure your service call. Upon completion of your service call, you may pay using the credit card on file (last four digits entered below), cash, or a company check.

Our service rates are as follows:

First Trip Charge of $225 which Includes Travel and the First Hour of Labor.
Labor: $130/hour in 1/2 hour increments after the first hour is completed.
Parts/materials are additional as needed.
These rates apply to work hours between 8:00 a.m. and 4:30 p.m, Monday through Friday. Overtime rates will apply to all work performed between 4:30 p.m. and 10 p.m. Monday through Friday and Saturday from 8:00 a.m to 4:30 p.m. Double Time Rates apply to all work performed after 10 p.m. Monday through Friday, after 4:30 p.m. on Saturday, all day Sunday, and on any Non-Working Holidays.

You may pay by Credit Card, Cash or Company Check.

Please read the terms of service and check the checkbox indicating that you have read and agree to them. We will then be able to book your call.

Today’s Date (If you are using Internet Explorer or Firefox, please input the date as (YYYY-MM-DD).>/label>

Company Name

Company Address

Your Name (as it appears on the card)

Your Email

Best Phone Number to Reach You (ex. 555-555-5555)

Credit Card Type (We accept Visa, Mastercard and American Express)

Credit Card Expiration Date
Month

Year

Last Four Digits of Credit Card

I have read and understand, and agree to pay for the service rendered per the terms above. If I do not have cash or a company check available, or if I am not at the service location when the work is completed, I then authorize Jay-Hill Repairs to charge my credit card on file (last four digits listed above).

Customer Signature:

Customer Initials:

Gas | Steam | Electric | Refrigeration | Ice | Warewashing | HVAC | Welding

New Customer Information/Payment Authorization Form

Remittance of this form is required to secure your service call. Upon completion of your service call, you may pay using the credit card on file (last four digits entered below), cash, or a company check.

Our service rates are as follows:

First Trip Charge of $225 which Includes Travel and the First Hour of Labor.

Labor: $130/hour in 1/2 hour increments after the first hour is completed.

Parts/materials are additional as needed.

You may pay by Credit Card, Cash or Company Check.

Please read the terms of service and check the checkbox indicating that you have read and agree to them. We will then be able to book your call.

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