Legally Binding Repair Authorization and Consent
This document serves as a formal and legally binding agreement between The Car Geeks Collision 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. 2133 Pembroke Rd, Hollywood, FL 33020, United States Phone Number: +1 786-786-1387
PLEASE READ CAREFULLY AND SIGN:
Name
*
Address
*
City
*
State
*
Zip
*
Phone
*
B. Vehicle Details
Description of Damage / Vehicle Problem
*
Photo of the Driver's License*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
VIN
Year and Make
*
Model
*
Photo of the Damage
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Photo of the Vehicle Registration
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
C. Insurance Information (Required if using Insurance) :
Claim #
Insurance Provider
Written Estimate?
*
REQUEST A WRITTEN ESTIMATE
DO NOT REQUEST A WRITTEN ESTIMATE AS LONG AS THE REPAIR COSTS DO NOTEXCEED $.______ THE SHOP MAY NOT EXCEED THIS AMOUNT WITHOUT MY WRITTENOR ORAL APPROVAL.
DO NOT REQUEST A WRITTEN ESTIMATE
AMOUNT NOT TO EXCEED
D. Consent
I authorize Car Geeks Collision 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.
I AGREE
Date
/
Month
/
Day
Year
Date
Signature
Continue
Continue
Should be Empty: