Repair Authorization

Repair Authorization

Please print the following form, fill out the fields, and fax it to
(954) 785-3793.

Or View a Printer-Friendly PDF HERE

AUTHORIZED AND ACCEPTED: You are hereby authorized to make the below specified repairs. I understand that payment in full will be due upon release of vehicle, including additional supplemental damage charges, and hereby grant you and/or your employees, permission to operate the vehicle herein described on street, highways or elsewhere for the purpose of testing and/or inspection. An express mechanic’s lien is hereby acknowledged the below vehicle to secure the amount of repairs thereto. We 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 our control. Storage charges will start 72 hours after repairs are completed if vehicle is not picked up at $60.00 per day.

Old parts removed from cars will be junked unless otherwise instructed.

All work performed has a warranty. Items that are not covered are damages that is acquired from driving conditions, improperly cleaning and environmental pollution damage. All rust repairs have no warranty.

Print the following form. Please sign 1-2-3 to begin repairs.

(1) I have received a copy of the estimate and disclosure.

Signed: ________________________________. Date: _________________

Estimated Cost of Repairs: $ __________. Revised Estimate: $ __________

(2) Repair order authorized by: ____________________ Date: __________

(3) 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 $100.00

[ ] I request a written estimate.

[ ] I do not request a written estimate as long as the repair costs do not exceed $ _________. The shop may not exceed this amount without my written approval or oral approval.

[ ] I do not request a written estimate.

Signed: ________________________________. Date: _________________

Direction of Payment

Insurance Company __________________________________

Claim # ____________________________________________

I __________________________ authorize the insurance company to make payment to 1st Class directly. If payment from insurance company is not paid to 1st Class directly, I agree I will be responsible for the supplement amount that was agreed upon with 1st Class and the insurance company.

Signed: ________________________________. Date: _________________