Windshield Hero's Insurance Work Order

I, The undersigned hereby authorize my insurance company to remit payment directly to Windshield Hero's for all parts and services detailed in this invoice. In the event my insurance company declines payment for any portion of the invoice, I acknowledge my obligation to settle the outstanding balance within thirty (30) days following such refusal. If I am not covered by insurance, I consent to pay the total amount due for services provided immediately upon completion, except where alternative payment arrangements have been pre-approved in writing by Windshield Hero LLC. Due to the process of using pressure and vacuum cycles to repair laminated glass and the unstable properties of broken glass, the damaged area may develop additional cracks or existing cracks may increase in length. This problem is very rare, and occurs in less than .1% of all windshield repairs performed. In the unlikely event this occurs, or we cannot repair the damage to your satisfaction, our liability is limited to a refund of any amount charged for the attempted repair. I now have been instructed as to the expectations; warranties and disclaimers involved with windshield repair, and understand Windshield Hero LLC's, policies regarding these matters and release them from any liability outside this agreement. Signing below indicates that you have read and agree to the terms set herein.