CAR Collision Center

Repair Authorization Form and Direction to Pay Shop

Form must be completed in full and signed before repairs started

Customer name: ___________________________________________ Reffered By: __________________________

Cell #:____________________________ (W) #:________________________ (H) #: _______________________ Fax #: ___________________________ Email:______________________________________________________ 2^nd repair: __________________ Ins Co: __________________________ Claim#: __________________________ Address:_____________________________________________City___________________St___________Zip_________________

Vehicle Year/Make/Model:___________________________________________________________________________________ Additional Concerns: ______________________________________________________________________________________

Payment Policy

Upon completion of the vehicle, any deductible, betterment or customer pay items must be paid for in full and in cash, or credit card. We do not accept personal checks. I understand that CAR Collision Center does not accept credit cards for the insurance portion of my bill (instead of the insurance check). I understand the vehicle will not be released to me until payment is received in full. It is the customer’s responsibility to secure third party endorsements. Insurance checks can be endorsed by all parties directly to the repair center. Vehicle owner will be responsible for any attorney fees and court costs related to collections of payments. A 3% fee will be added if you choose to deposit the insurance check and pay by credit card.

Please Remove Your Belongings: CAR Collision Center will not be held responsible for any items left in the vehicle

Please locate your radio & or any other codes. If the battery is disconnected, you will have to reset those codes.

Work Authorization:

1. I hereby authorize the repair work set forth to be done, along with the necessary parts and materials. The estimate of repair includes parts, labor, and diagnosis. If upon further inspection, additional repairs are needed, the primary payee will be contacted for authorization. The estimate is based on a visual inspection only.
2. I hereby grant your employees permission to operate my vehicle for the purpose of testing and/or inspection on streets, highways, or elsewhere.
3. I understand that if a third party provides a replacement vehicle, CAR Collision Center LLC is not responsible for costs, damages, or any liability.
4. Delivery dates given are approximate and will change if additional parts or repairs are needed. We will contact you if the delivery date originally quoted needs to be adjusted for any reason. If you have any concerns, please feel free to call us at any time.
5. There will be no refund available.
6. C.A.R. Collision Center LLC does not check out any mechanical and/or electrical components for old damage purposes and will not be held responsible in any way for non working components. C.A.R. Collision Center LLC will not be responsible for any glass damage.
7. We will not warranty any fiberglass repairs or any customer furnished parts. We will not be responsible if the air bag light comes on during repairs.
8. If vehicle is not picked up and paid in full after notification of repairs being completed there will be a $50 per day storage fee applied to the balance and the shop will not be held responsible for any over spray on vehicle. This storage fee includes if your vehicle has been stored (for estimates or any other reason) at the shop and you have decided not to have the repairs.

I have read and agreed to these terms.

Signed by: ____________________________________ Date:______________________