Authorization to Repair

Please fill in all information pertaining to the primary point of contact handling the repairs on the vehicle being left for repairs.

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Customer Name

E-mail address

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Primary Phone Number

Type of Vehicle

Customer Address

Insurance Company/Claim#

Work Authorization:

I hereby authorize the repair of the vehicle identified above by Brunswick Collision Center, or its affiliates, The Body Works of Virginia, Loudoun Collision Center and Nova Automotive Center. I agree that Brunswick Collision Center is not responsible for loss or damage to the vehicle or articles left in the vehicle in case of fire, theft or any other cause beyond the limits of garage owner’s liability. I also hereby grant permission to Brunswick Collision Center employees or its agents to operate this vehicle for the purposes of testing, transporting for related work, or inspection.

An expressed mechanics lien is hereby acknowledged on the above vehicle to secure the amount of repairs thereto. I further agree that if the amount due is referred to an attorney for collection, whether suit is instituted or not, to pay the said attorney twenty percent (20%) of the amount due as an attorney’s fee, plus any court costs.

Terms:

I acknowledge that the total estimate of repairs includes all parts, labor, handling, and diagnosis and agree that if closer analysis finds that additional repairs are necessary, I agree to approve additional supplemental repairs that will be paid for by the insurance company. I will be contacted for authorization if the amount I must pay will be increased. Acceptable methods of payments include insurance checks, cash, cashier’s check, MasterCard, Visa, and AMEX. Please do not cash or deposit the insurance check as it contains information necessary to process your claim. If your insurance check has been made payable to your lien holder and yourself, you must contact your lien holder for check endorsement.

There are many variables during the repair process not limited to parts availability, insurance company delays and other factors, which will affect both the cost of repairs on my vehicle, and the amount of time the vehicle will be needed for the repair. The estimated amount and estimated down time are exactly that – they are estimates based on what can be seen at the initial inspection. Brunswick Collision Center cannot be responsible for delays in repairs that are beyond our control including items listed above and rental car payments caps imposed under my insurance policy.

Power of Attorney:

For consideration of repairs made to this vehicle, I hereby grant power of attorney to sign or endorse any checks and/or drafts made payable to me and any release thereto as settlement for my claim for damage to this vehicle.

Direction of Pay:

I authorize Insurance Company to pay Brunswick Collisioin Center directly on claim number for all repairs including any supplements submitted. In the event the insurance, or the adjustment company inadvertently mails the settlement/supplement check to me in error, I hereby agree to notify the said Shop immediately, and I agree to deliver such check to the repair facility within 24 hours of my receipt of such check.

authorization

Hereby authorize Brunswick Collision Center to conduct a comprehensive inspection of my vehicle, for the purpose of evaluation. This authorization includes access to all relevant areas of the vehicle as needed for a thorough assessment.