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Authorization Of Repair Form

We want you to get your vehicle back as soon as possible! To speed up the process and save you a trip to our location, we’ve created this Authorization Form for you to fill out and submit online.  This form will give us authorization to proceed with repairs on your vehicle based on the estimates you have been provided.  All fields are required, and you must read and agree to the terms and conditions.

General Information

Enter your full name
Enter a valid email address
Enter a valid phone number
Enter your adress
Enter your city
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Enter a valid US zip code
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Enter a valid Vehicle License Plate Number
Enter insurance company name
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Terms & Conditions

By signing this form, I understand and agree to the following terms and authorize USA TOUCHUP AUTO BODY INC to repair the above-mentioned vehicle.

I hereby authorize the repair work to be done along with the necessary materials, and hereby grant you and/or your employees' permission to operate the vehicle herein described on the street highway, or elsewhere for the testing and/or inspection. I hereby authorize sublet repair, as you deem necessary.

Further, the undersigned, hereinafter called "Insured" for the consideration of repair made to "Insured's" automobile, does hereby grant to USA TOUCHUP AUTO BODY INC insured's Power of Attorney to sign or endorse any check and/or draft made to insured, and any release thereto as, settlement for insured's claim for damages to the above described vehicle.

**WE ARE NOT RESPONSIBLE FOR ITEMS LEFT IN VEHICLE**
***PART PRICES SUBJECT TO INVOICE*** AUTHORIZED AND ACCEPTED:

You are hereby authorized to make the above specified repair. I understand that payment in full will be due upon release of vehicle, including additional supplemental damage charges, and I hereby grant you and/or your employees, permission to operate the vehicle herein described on the streets, highways or elsewhere for the purpose of testing and/or inspection. An express mechanics lien is hereby acknowledge on above vehicle to secure the amount of repairs thereto. I accept responsibility for any attorney or collection fees related to the collection of unpaid balances. You will not be held responsible for loss or damage to vehicle or articles left in vehicle in case of fire, theft, accident or any other cause beyond your control old parts removed from vehicle will be junked unless otherwise instructed! I authorize any and all supplements payable direct to you. I authorize you to act as power of attorney to sign insurance checks to pay for damages to above vehicle. If cancel repairs prior to the completion for any reason, will be responsible for all tear down, reassemble, and storage fees.

We accept Visa, Amex, Mastercard, Discover, Debit. Cash & Personal checks. WE DO NOT ACCEPT BUSINESS CHECKS.

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