Mitchell Collision Repair Authorization

Name *

Phone *

Email *

Year, Make, Model: *

Insurance Company: *

Location *

Preferred Contact Method

Text
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Email

AUTHORIZED: *

I HEREBY AUTHORIZE MITCHELL COLLISION REPAIR TO PERFORM REPAIRS ON THE ABOVE REFERENCED VEHICLE. You and your employees may operate the vehicle for purposes of testing, inspection, sublet repairs, and delivery. Mitchell Collision Repair will not be held responsible for loss or damage to the vehicle or articles left inside in the case of fire, theft, accident, or other causes beyond our control. I understand Mitchell Collision Repair may access vehicle data from vehicle control unit for repairs and reprogramming.

AUTHORIZED: *

I AUTHORIZE THE INSURANCE COMPANY TO MAKE DIRECT PAYMENT TO MITCHELL COLLISION REPAIR. PAYMENT IS EXPECTED UPON DELIVERY OF VEHICLE, UNLESS OTHER ARRANGEMENTS HAVE BEEN MADE IN ADVANCE. We accept MC, Visa, Disc, AMX, Personal Checks (upon approval), money orders, and bank checks. We do not accept cash, traveler’s checks, or credit card checks. Company checks require prior approval. Please ask if you have further questions. $2500 limit on personal checks and CC payments.

I HAVE READ AND UNDERSTAND THE ABOVE TERMS *

PLEASE READ CAREFULLY, CHECK ONE OF THE STATEMENTS BELOW, AND SIGN. I UNDERSTAND THAT UNDER STATE LAW I AM ENTITLED TO A WRITTEN ESTIMATE IF MY FINAL BILL WILL EXCEED $100. *

I REQUEST A WRITTEN ESTIMATE.
I DO NOT REQUEST A WRITTEN ESTIMATE AS LONG AS THE AMOUNT DOES NOT EXCEED THE AMOUNT I SPECIFY.
I DO NOT REQUEST A WRITTEN ESTIMATE.

Signature *

(Signature)

Date *

LIMITED POWER OF ATTORNEY For consideration of repairs made to this vehicle, I hereby grant my power of attorney to sign and endorse any checks and/or drafts payable to me as settlement for my claims for repairs to the above listed vehicle.

(Signature)

Date *

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