Legally Binding Repair Authorization and Consent

This document serves as a formal and legally binding agreement between The Showroom Miami and the undersigned customer. By affixing your digital signature, you acknowledge your consent to the outlined repair services, terms, and conditions, and agree to comply with all relevant legal requirements. Please read carefully before proceeding.
Your Details:
Full Name*
Phone Number*
Email Address*
Street Address*

Street Address

Street Address Line 2

CityState

Zip Code
Description of Damage / Vehicle Problem
Photo of Driver's License

Cancelof
Vehicle Details:
VIN #*
Year*
Make*
Model*
Photo of Damage

Cancelof
Photo of Vehicle Registration

Cancelof
Insurance Information (Required if using Insurance) :
Claim #
Insurance Provider
Written Estimate?

REQUEST A WRITTEN ESTIMATEDO NOT REQUEST A WRITTEN ESTIMATE AS LONG AS THE REPAIR COSTS DO NOT EXCEED $_____ THE SHOP MAY NOT EXCEED THIS AMOUNT WITHOUT MY WRITTEN OR ORAL APPORVAL.DO NOT REQUEST A WRITTEN ESTIMATE
Consent to Electronic Communications & Electronic Signatures*

I authorize The Showroom Miami to contact me about my repair via phone, email, or text message and agree to any data rates that may apply. You may opt-out of communications at any time. The customer and The Showroom Miami agree that this Authorization Form may be executed and delivered by electronic signatures, in accordance with the Electronic Signatures in Global and National Commerce Act(ESIGN Act) and the Uniform Electronic Transactions Act (UETA). Both parties acknowledge that the signature appearing on this Authorization Form, whether electronic or manual, has the same force and effect and is the legal equivalent of your manual signature, as provided by the ESIGN Act and UETA
Signature*

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Date*

MonthDayYear
Date
Should be Empty:

Your Details:

Vehicle Details:

Insurance Information (Required if using Insurance) :