This agreement made _________, 19__, by and among the undersigned parties, in consideration of their respective undertakings.

The undersigned garage operator agrees to repair the automobile of A, to wit: _________, according to the attached estimate incorporated in this agreement, damaged when struck by an automobile, to wit: _________, driven by B, at _________, on _________, 19__, and to waive any lien on A's automobile for such repairs, and to release the automobile to A when it is repaired, and to hold B solely liable for the repairs.

B agrees to be solely liable for the repairs.

A agrees to the repair of A's automobile according to this contract and, upon satisfactory repair of A's automobile and release of it to A as aforesaid, without any liability on A's part for repairs, to release B from further liability for damages to automobile of A.

Garage operator: _________

By: _________