Information
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Job Number
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Driver Name
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Customer Name
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Date and Time
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Location
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Visibility Conditions
Vehicle Information
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Customer Vehicle Make
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Customer Vehicle Model
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Vehicle Registration Number
Damages - Specify each damage - where it is located/how much damage/what kind of damage
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Damage 1 Description
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Damage 1
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Damage 2 Description
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Damage 2
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Damage 3 Description
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Damage 3
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Damage 4 Description
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Damage 4
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Damage 5 Description
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Damage 5
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The signature below only constitutes an acknowledgement of the above noted condition at the time the vehicle was collected and does not necessarily imply an acceptance of responsibility.
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Drivers' Signature
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Customer's Signature
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Applicable only if the customer or their representative was not present at the vehicle collection: Dear Customer, At the time your vehicle was collected the condition was documented as above. Please call Mercedes-Benz immediately to discuss. Thank you.
