Work Authorization Form
I hereby authorize Paint Works LLC to inspect, disassemble, prepare, repair, refinish, and perform any other necessary work or labor on the vehicle listed below. I hereby grant permission for the work to be carried out, including the use of necessary materials, and I authorize you and your employees to operate the vehicle described on streets, highways, or elsewhere for the purpose of testing, inspecting, or outsourcing repairs. I acknowledge that an express mechanics lien is hereby placed on the vehicle listed to secure the amount of repairs, materials, and labor owed. This obligates me, as the primary debtor and/or my insurance company, either through me or directly, to remit payment to Paint Works LLC for all services, labor, repairs, parts, paint, and supplies as necessary. I understand that Paint Works LLC is not liable for the availability of parts or any delays in parts shipments beyond their control. Additionally, Paint Works LLC is not responsible for any loss or damage to the vehicle or items left in or on the vehicle, whether on Paint Works LLC property or not, in cases of fire, theft, weather, or any other cause beyond their control. Please note that Paint Works LLC does not accept personal checks.
*
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.
*
Yes
No
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Year, Make, Model
*
Vin Number
Insurance Carrier.
*
Claim Number.
*
Signature
*
Date
*
/
Month
/
Day
Year
Date
Submit
Should be Empty: