Motori Collision Centre Report

CRM*
Handler*
Rental*
REPAIR & PAYMENT AUTHORIZATION FORM
OWNER INFORMATION:
Customer Name*
Customer Telephone*
Customer Address*
Customer Email*
if no email. Please enter plate@no.com
Vehicle Information
Year*
Make*
Model*
Colour*
License Plate*
VIN*
MCC/{year}/{make}/{model}/{vin}/{licensePlate}
Deal Reference*
Insurance Information
Insurance Company*
Policy Number
Claim Number
Deductible Amount
Date of Loss*

MonthDayYear
Date
Date Verified*

MonthDayYear
Date
Adjuster Name
Adjuster Telephone
Adjuster Email
example@example.com
Notes
REPAIR AUTHORIZATION – IN
I hereby authorize Motori Collision Centre (the “Repairer”) to perform the repair work described herein and further authorize the operation of the vehicle described herein (the “Vehicle”) for the purposes of repair. I understand that all estimates are for labour only. Materials are additional and could vary due to changes in prices from the manufacturer. I also agree the Repairer shall not be liable for damage to or loss of personal items left in the Vehicle. I agree that the Repairer shall be entitled to reasonable storage charges in the event that the Vehicle has not been removed from the premises within 24 hours after notification that the repairs have been completed. I agree that the Repairer may hold the Vehicle until payment has been made in full. NO GUARANTEE ON RUST REPAIRS.

VEHICLE ACCEPTANCE AND DIRECTION REPAYMENT – OUT
I, being the owner of the Vehicle or the owner’s authorized representative, accept return of the Vehicle having inspected the repairs. So far as visual inspection and operation of the Vehicle (where appropriate) indicate, the repairs appear to have been performed in a good and workman-like manner. I acknowledge the indebtedness of the owner for the repairs and hereby direct the insurer noted herein to make payment directly to the Repairer or Repairer’s lawful assignee, either of whom is authorized to endorse the owner’s name on a cheque made payable to the owner or made jointly payable. I agree that release of the Vehicle hereunder is conditional, that pending payment in full the Owner holds the Vehicle as agent for the Repairer, and in the event of non-payment, in whole or part, for any reason whatsoever, the Repairer or Repairer’s agent may repossess the Vehicle and hold it until payment has been made in full, payment in such case to include interest charges and all costs incurred in repossession and storage of the vehicle.

I have read the above terms and conditions and hereby authorize Motori Collision Centre to repair my vehicle.
Signature of Vehicle Owner/Authorized Representative*

Clear
Date*

MonthDayYear
Date
By initialing the box and submitting this form, I voluntarily give my consent to Motori Auto Group to contact me for follow-up services, promotions, and after-service survey reviews. I understand that I may receive communication via phone, email, or text message, and that my contact information may be used for marketing purposes. I acknowledge that my consent is voluntary, and I may withdraw my consent at any time by contacting Motori Auto Group at autobody@motoriauto.ca. I also understand that I may opt-out of receiving promotional messages or update my contact information at anytime.

I voluntarily give my consent to Motori Collision Centre to install a Motori Auto Group license plate cover on my vehicle after service/repair.
Initialing / Signature of Vehicle owner / Authorized Representative.

Clear
Should be Empty:

REPAIR & PAYMENT AUTHORIZATION FORM

OWNER INFORMATION:

Vehicle Information

Insurance Information