Work Auth SJ

UNIQUE COLLISION REPAIR CENTERS
Name*
Cell Phone*
Address*
City*
State*
Zip*
Email*
example@example.com
PERSONAL VEHICLE INFORMATION
Car Year*
Make*
Model*
Are you getting a rental?*

YesNo
INSURANCE AND PAYMENT INFORMATION
Ins Company
Deductible Amount
Claim #
Have you been pre-paid from insurance?*
Amount pre paid
How would you like to receive vehicle status updates?*
FOR TESLA OWNERS ONLY:

I grant permission for the shop to initiate Service Mode on my vehicle. I understand that while my vehicle is in Service Mode, all mobile access will be relinquished.
Initial
AUTHORIZATION TO REPAIR:

The Estimate to Repair includes parts, labor and diagnoses. If, on further inspection additional parts or repairs are needed, I authorize the shop to contact either myself or insurance for funds needed. We are not responsible for loss or damage to your vehicle from fire, theft, accidents or any cause beyond our control.

I authorize the repair work to be done along with the necessary material and hereby grant your employees permission to operate the vehicle for the purpose of testing and inspections. An express mechanic's lien is hereby acknowledged on the vehicle to secure the amount of the repairs. My signature authorizes you to endorse and cash any draft made payable to me for the repairs authorized.

I grant permission for my vehicle to be moved to another Unique Auto Body location for purposes of load balancing.
Signature*

Clear
Date*

MonthDayYear
Date
Drop-Off Time*

Hour Minutes

AM/PM Option
Should be Empty:

UNIQUE COLLISION REPAIR CENTERS