Autonix Service Form

Name *

Phone *

Email Address *

Pick Up Address *

Apartment, suite, etc *

City *

State *

ZIP / Postal Code *

Drop Off Address *

Apartment, suite, etc *

City *

State *

ZIP / Postal Code *

Street Address Errand 1

Apartment, suite, etc

City

State

ZIP / Postal Code

Street Address Errand 2

Apartment, suite, etc

City

State

ZIP / Postal Code

Pick Up Date *

Concierge Pickup

Pick Up Time *

Hours

Minutes

AM/PM

Vehicle Make / Year / Model *

Vehicle Vin # *

Concierge Pick UpConcierge Pick Up

Priority ServicePriority Service SlotExpress Return Priority SchedulingEarlier Pickup / Return Windows

Upload fileUpload Errand List / ID

No file chosen

Additional Information

Hybrid ServicesHybrid Battery InstallHybrid Battery Test

Service Estimate

Estimated Total: ${calculation-1}

Service Fees & Policies
• A $50 concierge pickup & drop-off fee applies to services requiring vehicle transportation and is added before checkout.
• A $25 cancellation fee applies to late cancellations (within 24 hours).
• A $50 no-show fee applies if the vehicle is unavailable at pickup.

Thank you for booking with Autonix!

Total

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