Year, Make & Model
Services Requested

SECTION 5 — FINAL SCREENING

I acknowledge that I have reviewed EXQUISITEMAD®’s proprietary service rates and understand that all travel-related expenses are separate and billed in addition to the quoted service rates.
YesNo
Interested in third-party Synchrony financing (subject to approval, terms & conditions)? YesNo
Do you and or your company have insurance coverage for the asset(s)? YesNo
Are you and or your company the titled owner of the asset(s)? YesNo
Preferred payment method
Bank (ACH / WIRE)Synchrony (Third Party Financing Subject to terms and Approval)Credit Card

SECTION 6 — SIGNATURE & ACKNOWLEDGMENT

By submitting, I certify the information is accurate and understand that Exquisite Mobile Auto & Aviation Detailing EXQUISITEMAD LLC:

• All terms, disclaimers, and policies governing EXQUISITEMAD®’s services—including deposits, refunds, liability, and operational procedures—are published at
  www.exquisitemad.com/faqs.

• This form does not constitute a contract, service agreement, or guarantee of scheduling. No appointment is confirmed until EXQUISITEMAD® has received a signed service agreement, the required deposit, and any applicable travel expense payments.

• Individual service agreements may include additional or modified terms, disclaimers, and defined scope of work based on the specific project, asset type, or worksite context.

I have read, understood, and agree to EXQUISITEMAD®’s terms, disclaimers, and policies as stated above and published at www.exquisitemad.com/faqs. Name / Title* Signature (type full legal name)* Date* I consent to the processing of my information for the purpose of service qualification. All data is confidential and governed under Florida Law.