(3) If a customer initiates a request for service or parts for the repair of a motor vehicle without receiving a written estimate and voluntarily agrees to pay all reasonable costs of repair up to an amount stated by the customer, a facility may obtain from the customer a waiver of his or her right to receive a prior estimate of repair costs. The waiver shall be in 14 point or larger bold capital type face and executed with 1 copy to the customer who is requesting the repairs. The waiver shall read as follows: "I, __________, voluntarily authorize __________ to provide services or parts in the repair of the below described motor vehicle without receiving an estimate of repair costs. By signing this form, I understand that I will give up my right to:
1. Receive a written estimate of the cost for repairs;2. Approve in advance any repairs or costs with a total cost under $ __________; and3. Refuse to pay for repairs with a total cost less than the amount stated above. The facility may exceed the amount stated above only after I give my written or oral approval.
Motor vehicle description:
Customer signature _______________
Date __________
Time __________".