AUTHORIZATION AND DIRECTION OF PAY Step 1 of 2 50% Name* First Last Prestige Collision Center is authorized to perform the above listed and attached RO# repairs and any SUPPLEMENTAL repairs necessary to return my vehicle to PRE-COLLISION condition. I understand that Prestige Collision Center will notify ME and any INSURANCE CARRIER involved of the cost and need for any supplemental repairs prior to performing the same. PRESTIGE COLLISION CENTER having notified all parties as to the need for these repairs, will consider authorization in force unless specifically instructed not to proceed with our sole concern being the timely completion of repairs. I hereby grant to you and/or your employees, permission to operate the car, truck or vehicle herein described on streets, highways or elsewhere for the purpose of testing and/or inspection, transporting to and from your sublet vendors and to test drive or delivery. Prestige Collision Center will use its choice of professional and qualified suppliers and vendors when sublet repairs are required and cannot be performed by our company due to the nature of collision repairs. Right to Receive Replaced Parts Notice/Waiver: A customer of this shop has the right to receive the replaced parts from vehicle. Customer is hereby notified that there will be a $50.00 fee per day for storing the replaced parts commencing on the date the vehicle is delivered or the date the repairs are paid for, whichever comes first if the parts are not picked up by customer at that time. Do You Want Your Replaced Damaged Parts?* I DO NOT want my replaced damaged parts. I DO want my replaced damaged parts. Notice of Right to Inspect Repairs Before Making Payment: Customers of this shop or his/her insurance company have the right to inspect the repaired vehicle before paying for the repairs. Warranty Terms & Limits: These repairs are covered by a limited warranty. Labor for a period of lifetime. Parts and materials subject to the terms as extended by each manufacturer or vendor. Warranty repairs to be performed at seller’s place of business. Seller hereby limits implied warranty to the period stated. Storage Notice:: Customers of this facility are hereby notified that we charge storage at the rate of up to $150.00 per day outside and $200.00 per day inside on vehicles left at our facility that we do not repair and on vehicles left at our facility for more than three days after being notified the vehicle is ready to be picked up. Estimated Date of Delivery Notice: Estimated date of delivery may change due to parts delay or backordered parts, weather conditions, insurance related delays or unforeseen and uncontrollable factors. Payment:: I understand the sole responsibility for payment is mine and that all charges are due upon delivery. I further understand and agree that if my INSURANCE CARRIER is billed and fails to pay for the agreed repairs I will pay all outstanding sums immediately. PAYMENT is to be made by INSURANCE COMPANY DRAFT, CASH, CASHIERS CHECK, or MONEY ORDER. It is understood that an express garage keeper’s lien exists against the vehicle herein described and its contents. I further understand and agree that all charges for labor, parts, storage and towing must be paid prior to the release of my vehicle. Execution of such lien shall in no way waive our rights to a civil cause of action and shall include reasonable attorney’s fees which may be necessarily incurred. If there is a legal owner of your vehicle i.e.: BANK or FINANCE COMPANY we may require additional information from you. By placing my signature below, I hereby acknowledge and agree to the terms and conditions of this authorization. Print Name:* Date* MM slash DD slash YYYY AUTHORIZES PRESTIGE COLLISION CENTER TO DO THE REPAIRPower of Attorney – Prestige Collision Center I do hereby appoint the aforementioned business 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 or bills of exchange for deposit to the aforementioned business’ account for credit on my account for repairs on my vehicle which has been released and accepted.. Print Name:* Date* MM slash DD slash YYYY By attaching this document to the estimate it shall be considered a part of the Estimate/Repair order. AUTHORIZES INSURANCE COMPANY TO SEND US PAYMENT DIRECTLY ANY CHECKS RECEIVED BY INSURED/CLAIMANT MUST BE TURNED OVER TO THE AUTOBODY SHOP IMMEDIATELY. ANY ATTEMPT TO WITHHOLD PAYMENT AFTER SIGNING THIS DOCUMENT COULD RESULT IN THE INSURED/CLAIMANT BEING CHARGED WITH INSURANCE FRAUD AND FINED UP TO $5,000.00. Accepted By:* Date:* MM slash DD slash YYYY By attaching this document to the estimate it shall be considered a part of the Estimate/Repair order. AUTHORIZED INSURANCE COMPANY TO SEND US PAYMENT DIRECTLY ANY CHECKS RECEIVED BY INSURED/CLAIMANT MUST BE TURNED OVER TO THE AUTOBODY SHOP IMMEDIATELY. ANY ATTEMPT TO WITHHOLD PAYMENT AFTER SIGNING THIS DOCUMENT COULD RESULT IN THE INSURED/CLAIMANT BEING CHARGED WITH INSURANCE FRAUD AND FINED UP TO $5,000.00. REMINDERS: Sometimes our customers forget to remove, or leave personal or necessary items in the vehicle. INITIALS* WE ARE NOT RESPONSIBLE FOR PERSONAL ITEMS LEFT IN THE VEHICLE. YOU WILL BE PROVIDED WITH WEEKLY UPDATES ON REPAIR STATUS UNLESS OTHERWISE REQUESTED. Cell PhoneE-mail Home PhoneBusiness PhoneText Message *Message & Date rates may applyWE CAN TEXT TO YOUR PHONE VIA EMAIL. IF YOU WOULD LIKE TO RECEIVE TEXT UPDATES, PLEASE PROVIDE YOUR CELL# AS WELL AS YOUR CELL PHONE SERVICE PROVIDER Cell Phone Provider Any additional concerns regarding the repairs? Would you like any other estimates or repair work done while the vehicle is here i.e. stone chip repair, etc.? DetailINITIALS TRANSFERS: I hereby grant Prestige Collision Center permission, in the case of a work flow balance, to transfer my vehicle to any of our 6 locations to expedite my collision repairs. I will pick up my vehicle at the location of my choice.INITIALS* ATTENTION: Many parts suppliers DO NOT accept return of parts. If suppliers DO accept returns, there is a restocking fee. Should you cancel your scheduled repair appointment with less than ONE WEEK’S NOTICE or are a NO-SHOW for your scheduled appointment, these restocking fees or parts costs will be billed to you. You will be responsible for any attorney fees and court costs related to collections of paymentsINITIALS* NOTE: WE MAY NEED TO DISCONNECT YOUR BATTERY DURING THE REPAIRS SO YOU MAY NEED TO REPROGRAM YOUR RADIO STATIONS. Privacy Policy: Upon completion of the vehicle, any deductible, betterment or customer pay items must be paid for in full and in cash, certified funds, Visa, MasterCard of Amex*. I understand the repair center does not accept credit cards for the insurance portion of my bill. I understand the vehicle will not be released to me until payment is received or arrangements have been made for payment with the primary payee. It is the customer's responsibility to secure third party endorsements. Insurance checks can simply be endorsed by all parties directly to the repair center. Vehicle owner will be responsible for any attorney fees and court cost related to collections of payments. ***$1,000.00 maximum for credit card payments INITIALS* Privacy Policy: Your information will not be sold to any party outside of our direct control. Any personally identity information regarding you and/or repairs us strictly confidential.
