Repair Authorization Form Logo
  • SMITTY'S MAINTENANCE REPAIR & COLLISION, INC.

    3301 FREEMANSBURG AVENUE EASTON, PA 18045 * 610-258-5297
  • TAX ID 23-2915063

  • Repair Authorization Form

  • Estimates performed prior to disassembly of vehicle are not accurate due to the probability of hidden damage. Therefore, it is our practice that accurate estimates of the cost to repair and the expected time to complete repairs, are not made until we have disassembled the area of damage to your vehicle. Note: After disassembly additional repair and parts will cause delays.

    Before dropping off your vehicle, please ensure it is washed and that all personal belongings are removed. If Smitty’s Maintenance Repair & Collision needs to remove and store any items left inside the vehicle, a fee may be charged. Smitty’s Maintenance Repair & Collision is not responsible for any missing belongings left in the vehicle during the repair process.

    Additionally, Smitty’s Maintenance Repair & Collision is not liable for any damage caused by fire, theft, vandalism, or other incidents, whether occurring inside or outside the vehicle.

    Be aware, Smitty’s Maintenance Repair & Collision, Inc. labor rates are posted in the collision office. Smitty’s will review all insurance estimates for an acceptable labor rate and parts replacement. If we do not accept the insurance estimate, you may or we may contact the insurance company to discuss the labor rate and parts replacement. If in a rare situation, Smitty’s and the insurance company cannot agree on an accepted labor rate, the customer will be responsible for any difference. There may be instances when the insurance company expects Smitty’s to purchase parts outside of our normal vendor accounts. We will make the effort to make the purchases requested by your insurance company however some parts may no longer be available or they may be inferior parts below our standard of quality. Smitty’s will do everything within our limits to work with your insurance company however it is our warranty for the work performed “NOT THE INSURANCE COMPANIES.” We take pride in the quality, service, and safety that we provide to you as our customer. 

    Employees of Smitty's and its sublet vendors may occasionally operate your vehicle for testing, moving, or pickup/delivery purposes. During the process of repair, it is normal for the battery to be disconnected which may result in memory presets.

  • CANCELLATION FEES: Once the repair authorization is signed by customer, parts will be ordered per the estimate. If Smitty's does not repair your vehicle, there will be an estimate fee, fee for administrative time to process vehicle prior to repair, any labor performed in regards to disassembling and estimating the damage, parts, restocking fees for parts and materials, storage for the time the vehicle was in our possession, and any other fees reasonably incurred by Smitty's related to your vehicle.

  • SUPPLEMENTAL/ADDITIONAL DAMAGES: During the teardown process of repairing said vehicle additional damage may be found.  Smitty’s Maintenance Repair & Collision, Inc. will complete a supplement damage analysis.

    ·         Insurance Claim: Smitty’s Maintenance Repair & Collision, Inc. will submit the additional damage estimate to insurance for approval. Repairs will be on hold until approval is received from the insurance company. The vehicle owner will be notified of the additional damage for approval. 

    ·         Supplement Payments from Insurance: I agree to allow my insurance company handling the claim to issue supplement payments directly to Smitty's Maintenance Repair & Collision, Inc. once the supplement has been approved. I understand that any payment not received by the time the vehicle repair is complete may delay the delivery of the vehicle. If payment has not been received, proof of payment from the insurance company will be required to release the vehicle.

    ·         Customer Pay and Third Party Pay: The vehicle owner will be notified of the additional repairs for approval. The vehicle owner will be financially responsible for the additional cost.  Refer to our Payment Policy for financial responsibility and payment methods.

     

  • PAYMENT POLICY - The vehicle owner accepts full financial responsibility for all repairs performed on the vehicle. Any additional costs required to restore the vehicle to its pre-accident condition are also the sole responsibility of the vehicle owner, regardless of insurance or third-party contributions.

    ·         2% Credit Card Fee: A 2% convenience fee will be applied to all collision repair payments made using credit, debit, or check cards. We also accept Insurance checks, Cashier's checks, Money orders, and Cash with no additional fees.

    ·         Personal and Business Check payments are accepted only if received 14 days prior to repair schedule start date.

    ·         Returned Check Fee: If a check payment is returned unpaid for any reason, the customer agrees to pay the full amount of the check plus a $30 returned check fee within 24 hours of notification. Payment must be made by cash only.

    ·         Customer Pay: A 50% deposit of the Estimate of Record is required no later than two weeks prior to the vehicle’s scheduled repair date.

    ·         3rd Party Payment Terms: 100% of the Estimate of Record is due no later than two weeks prior to the vehicle’s scheduled repair date. Please note that our agreement is with you, the vehicle owner, and not with any third-party payer. We do not offer third-party billing. Any remaining balance is due in full at the time of vehicle delivery. It is solely the customer’s responsibility to seek reimbursement from the third party.

    ·        Change to Insurance Coverage:
    If the vehicle owner or third-party payer decides to switch to insurance coverage after repairs have begun, the customer will be financially responsible for:
    • An administrative fee of up to $250, and
    • Any balance not covered by the insurance provider.

    ·         Rental: If the vehicle owner chooses to use a rental vehicle—whether paid by themselves, their insurance provider, or a third party—Smitty’s Maintenance Repair & Collision, Inc. is not responsible for any rental fees or associated charges.

    ·         Vehicle Completion: Vehicles are expected to be picked up within 24 hours of notification of completion unless other arrangements are made. If a vehicle is not picked up within three (3) days of notification, Smitty's reserves the right to assess storage fees at our posted daily rate.

    ·        Insurance Payment and Financial Responsibility Acknowledgment: I understand that the insurance company may have already issued the original estimate check for payment towards the repair of my vehicle. Any such check that I receive is to be promptly turned over to Smitty’s Maintenance Repair & Collision, Inc.

    I acknowledge that Smitty’s Maintenance Repair & Collision must verify payment before releasing the repaired vehicle. If payment cannot be verified, it is my responsibility as the vehicle owner to pay for the repairs in full at the time of vehicle delivery. I understand I will be reimbursed once the insurance payment is received by the shop.

    I also acknowledge that I am responsible for any: Deductible amounts, Adjustments for depreciation and/or betterment, and Any portions of labor, parts, or materials not covered by my insurance, as required by state law to restore my vehicle to its pre-accident condition. If Smitty’s Maintenance Repair & Collision, Inc. is not a direct repair facility for my insurance company, I acknowledge and accept responsibility for any labor rate differences or additional costs not covered by insurance.

    ·        All customer-responsible repair costs must be paid in full before the vehicle will be released. If an insurance company is covering part or all of the repair, we must receive direct payment from the insurer or valid proof that payment has been issued to us before releasing the vehicle.

     

  • Insurance Follow-Up and Payment Authorization

    In some cases, your assistance may be required to follow up with the insurance company to ensure timely payments. If the insurance company does not respond to our submission for supplements and/or payments, we will require the customer to contact and follow up with the insurer directly.

    Authorization
    By signing below, you authorize Smitty’s Maintenance Repair & Collision, Inc. as your Power of Attorney to communicate with the insurance company and endorse your name on any insurance check issued for the purpose of paying for repairs to your vehicle.

  • Texting Consent:  Smitty's Maintenance Repair & Collision, Inc. would like to send text (SMS) messages to the mobile number you have provided in our records. By signing this form, you are agreeing to receive text (SMS) messages from Smitty's Maintenance Repair & Collision, Inc. relating to my vehicle repairs. Message frequency varies. Message & data rates may apply. Reply STOP to opt-out at any time. 

  • Photo/Video Disclosure: Please be aware, Smitty's Maintenance Repair & Collision, Inc. may take photos/videos of said vehicle during the repair process and may use the photographs/videos in publications or other media material produced by Smitty's including but not limited to: brochures, website, advertising, social media, etc. I agree the photos/videos will become the property of Smitty’s Maintenance Repair & Collision, Inc. I will receive no financial compensation for the photos/videos. I hereby release any and all claims against any person or organization utilizing the material for the purposes listed but not limited to those listed.

  • I have read the above paragraphs and I hereby authorize the repair to the above referenced vehicle as described in the estimate and acknowledge that I understand all the above.  Smitty's is not responsible for the security or condition of any personal property left in the vehicle. An express mechanics lien is hereby acknowledged on this vehicle to secure the amount of repair thereto.

  • Powered by Jotform SignClear
  •  - -
  • Should be Empty: