dtp by wanghonghx


									Authorization to Repair
Name: ____________________________ Address: _____________________________
City: ______________________________ State: _____________ Zip: _____________
Phone Cell: ________________ Work: ________________ Home: ________________
Vehicle Year: _____ Make: ___________ Model: _____________ Color: __________
 The Estimates and/or Supplements may include parts, labor, diagnosis, towing and sublet repairs. If
upon further inspection, additional items need repair or replacement, you or your insurance company
will be contacted for authorization. We are not responsible for loss or damage to your vehicle from fire,
theft, accidents, acts of God or any cause beyond our control. If the vehicle is picked up by the customer
before authorized repairs are completed, the customer may incur charges for repairs completed to date,
diagnostic fees, reassembly charges, storage charges and parts return charges. All repairs are considered
cash unless a prior agreement is made. Insurance checks may be signed over toward payment of repairs.
Vehicles left at the Collision Center after repairs are completed may incur storage charges if not picked
up in 10 days. Vehicles that are a total loss may incur storage charges from the date dropped off.

 I ______________________________, hereby authorize Tallahassee Ford Collision Center to repair
my vehicle per the Estimates, and/or Supplements required to complete the repairs and I allow its
employees and/or agents of Tallahassee Ford Collision Center to operate my vehicle on public roads for
the purpose of test drives, diagnosis, inspecting and/or transporting for sublet repairs. I also
acknowledge Tallahassee Ford Collision Center’s right to an express mechanic’s lien or garage keeper’s
lien on the vehicle for the full amount of repairs and/or charges and that I have no right of possession of
the vehicle until the repairs have been paid in full or voluntarily released to me pending full payment. I
agree that Tallahassee Ford Collision Center is not responsible for loss or damage to the vehicle or
articles of value left in the vehicle as a result of fire, theft, accidents, and/or acts of God or any cause
beyond their control or for any delays caused by hidden damage, prior damage, rust damage, parts
shipment delays, unavailable or backordered parts, insurance inspections, disputes and/or coverage for
the claim or inclement weather.

Direction of Pay: I do hereby appoint Tallahassee Ford Collision Center as my attorney in fact, to
accept on my behalf any and all checks, drafts or bills of exchange and to endorse all such checks,
drafts, bills or repair authorizations for use by or for deposit to Tallahassee Ford Collision Center
business account for credit to my account for the repairs to my vehicle.

Authorized Signature: X ____________________________ Date: _______________

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