Work Authorization Form
I, the undersigned, hereby authorize Paint Works LLC to perform all necessary repair work on my vehicle as outlined in the provided estimate, including but not limited to parts, labor, paint, diagnostics, and any additional services deemed necessary upon further inspection. I grant permission for Paint Works LLC and its employees to operate the vehicle on public roads or elsewhere for testing, inspection, sublet work, pick-up, or delivery purposes, at my own risk. MECHANIC'S LIEN: I acknowledge and agree to an express mechanic's lien on the vehicle to secure the full payment for repairs, materials, and labor provided. I am fully responsible for the payment of all charges related to the repair services, including any additional work authorized by myself or my insurance company. LIMITATION OF LIABILITY: Paint Works LLC shall not be held liable for any loss or damage to the vehicle or personal items left in the vehicle due to fire, theft, accident, weather, or any cause beyond Paint Works LLCs control. Additionally, I understand that Paint Works LLC is not responsible for delays in the availability or shipment of parts beyond its control. DEDUCTIBLE CONFIRMATION: I acknowledge that I am responsible for the payment of the deductible amount per my insurance agreement to Paint Works LLC. ADDITIONAL REPAIRS AUTHORIZATION: I understand and agree that any additional repairs deemed necessary will require authorization either from myself or my insurance company before proceeding. DIAGNOSTIC & DOCUMENTATION CHARGES: If Paint Works LLC does not complete any repairs and return the vehicle, I understand that a diagnostic and/or Documentation charge may still be applied to the bill. STORAGE FEES:I acknowledge that storage fees of $25 per day will apply 72 hours after the completion of repairs if the vehicle is not picked up within this timeframe. LEGAL FEES: In the event that legal action is required to enforce this agreement, I understand and agree that I am solely responsible for all associated costs, including attorney fees and court costs for both parties. PAYMENT TERMS: I understand that payment is due upon vehicle pickup unless otherwise authorized in writing. Paint Works LLC may not accept personal checks. **POWER OF ATTORNEY** I hereby grant Power of Attorney to Paint Works LLC for the purpose of endorsing any checks or drafts issued by my insurance company for the payment of repair costs. I direct my insurance company to remit payment directly to Paint Works LLC for the full amount of the repairs as outlined in the repair estimate, supplement invoice, adjuster’s report, or Fees.
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I Authorize and Agree to the stated terms and conditions.
I hereby authorize Paint Works LLC to use photos and/or videos of my vehicle, its parts, paint, or the work performed by Paint Works LLC on their website or social media platforms.
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Yes
No
Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
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example@example.com
Phone Number
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Format: (000) 000-0000.
Year, Make, Model
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Vin Number
Insurance Carrier.
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Claim Number.
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Signature
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Date
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Month
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Day
Year
Date
Submit
Should be Empty: