Repair Authorization

Collision Repair Authorization Form

Please complete this form to authorize collision repair work on your vehicle. Your signature below grants permission for the repairs to be performed as described.
Collision Repair Center
18154 Parthenia St
Northridge CA 91324

Phone 818 341 7900
Fax 818 341 7901
Email contact@crcnorthridge.com
Customer Name*

First NameLast Name
Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Cell Phone
Please enter a valid phone number.
Home Phone
Please enter a valid phone number.
Vehicle Year*
Vehicle Make*
Vehicle Model*
Vehicle Color*
License Plate
Odometer
Reference / Claim #
Insurance Company
Special Instructions
Date In

MonthDayYear
Date
Date Out

MonthDayYear
Date
Estimator
Estimator Phone

Customer Authorization
I authorize Collision Repair Center to perform the repairs listed in this estimate, including any necessary parts, materials, and sublet services. I understand that all final charges will reflect the actual parts and labor required to complete the repair.

Collision Repair Center is not responsible for loss or damage to the vehicle or any articles left in the vehicle in the event of fire, theft, or any cause beyond our control.

I acknowledge that I have removed all personal belongings from the vehicle and authorize the repair facility to operate the vehicle for testing, inspection, or delivery.
Customer Signature*

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Authorization Date*

MonthDayYear
Date
Should be Empty:

Collision Repair Authorization Form