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Vehicle InformationYear*Make*Model*MileageLicense PlateVINVehicle Color*Vehicle DamageDamaged Areas Left Rear Left Side Left Front Front Right Front Right Side Right Rear Rear Additional Comments for Service Writer Please include any relevant information to the operation of the vehicle. How does the car drive? How does it feel? Anything specific you want your Technician and Service Writer to know about the Cosmetic and/or Mechanical condition of the vehicle? Repair Payment ResponsibilityAre Your Repairs an Insurance Claim or Out Of Pocket?* No Insurance – Out Of Pocket Repairs I Have An Insurance Claim Insurance Company NameClaim NumberAre You A Claimant or Insured? Claimant – Not At Fault Insured – At Fault Claimant – Someone who is claiming repairs on another person’s insurance policy due to a “Not At Fault” Accident. Insured – Someone who is claiming repairs on your own insurance and a deductible is applied. Deductible Amount (if applicable) Typically only applies when you are going through your own insurance. The deductible is your co-pay. Additional Comments for Service Writer Please include any insurance company direct contact information, for example: Insurance Adjuster name and number. Also, please include anything you would like your service writer to know about the insurance claim to your vehicle and/or any special administrative requests from our office. Repair Authorization Agreement Repair Authorization Agreement The staff at The Collision Center realizes it is very inconvenient to be without your vehicle. We promise to return your vehicle to you as quickly as possible without compromising the quality of repairs just to meet a target date. We can only estimate a completion date and cannot guarantee exact completion date or time due to the complex nature of the repair process. We do not accept any liability for rental car fees that exceed your insurance company limits. Factors to consider that may occur during the repair of your vehicle: Reinspection: If hidden damage is discovered, we must stop work, notify the insurance company and await their reinspection and approval of the additional damages found before repair work can resume. Their supplemental paperwork must also be received to proceed as this confirms the agreedupon revised repair procedures. Parts: If hidden damage requires additional parts of the factory cannot get us a part for several days, the repairs will be delayed. I authorize The Collision Center to order parts on my behalf for the repairs of my vehicle Color Match: Every color is slightly different. Even a new vehicle will require color tinting. It often takes our technicians more than two hours to properly tint the color. Reassembly: Because we take great pains to prevent overspray and future paint peeling, we remove attached parts from painted and blended panels. Therefore, it is necessary for our technicians to reinstall parts onto freshly painted surfaces. This must be done with great care and is often time consuming. Weather: Cold weather causes all paint to dry very slowly. Hot weather may cause chemical reactions due to drying too quickly. Previous Repairs: If your vehicle was previously repaired in the same area currently under repair, it is often necessary to do additional repairs to the old ones so our work can be guaranteed. In the event that we cannot repair your vehicle, there will be a charge for any labor performed in regard to disassembling and estimating the damage. I understand that The Collision Center will NOT be held responsible for theft of vehicle or missing articles left in vehicle such as: iPods, cameras, sunglasses, credit cards, money, CD’s, golf clubs, etc. Please remove all items from your vehicle before or when you drop off your vehicle for repairs. All charges for repairs MUST be paid when vehicle is ready for pickup/delivery. Vehicle will not be released until payment has been made in full. You authorize us to endorse your name on any insurance checks made for the purpose of paying for repairs to your vehicle. We accept all major credit/debit cards, Insurance company checks, and cash. Please note there is a 3% fee for all credit/debit card transactions. If payment for cost of repairs and storage charges are not paid within 30 days of the notified repair completion date, The Collision Center will file a Mechanics/Body Shop Lien on the above vehicle in order to secure the balance due (including but not limited to; cost of repairs and/or storage charges). A daily storage charge may be applied of up to $150.00 per day for motor vehicles that have not been picked up after 3 business days from the date of the notified repair completion date. The Collision Center and its sublet vendors may occasionally operate your vehicle for testing, moving, or pickup/delivery purposes. Also, during the process of repair, it is normal for the battery to be disconnected which may result in loss of radio station or other memory presets. All repairs come with limited lifetime warranty as long as you own the vehicle. Please reference our Lifetime Warranty Certificate. ID PHOTO REQUIREDUpload front of Driver's License or Government ID*Accepted file types: jpg, png, pdf, Max. file size: 200 MB.SignatureConsent* I have read, understand, and agree to the terms above. (required before proceeding)PhoneThis field is for validation purposes and should be left unchanged.