Repair Authorization Form

I hereby authorize Performance Collision Centers to repair and negotiate on my behalf with the responsible Insurance Company, the cost if necessary, to restore my vehicle to pre-loss condition. I do hereby grant Performance Collision Centers power of attorney for signing my name to one and all checks or drafts due from the responsible Insurance Company for repairs to my vehicle. I also authorize the Insurance Company to make payment directly to Performance Collision Centers for any and all balances required for the repair of my vehicle.

I am aware that the insurance company may have already sent me an original estimate check that will be used to repair my vehicle. I hereby acknowledge that any check I receive from the insurance company is to be turned over to this repair facility to repair my vehicle. I also acknowledge that if we are to repair your vehicle, we must verify payment prior to releasing your vehicle to you. If we are unable to verify payment, it is the responsibility of the owner of the vehicle to pay the bill and we will gladly reimburse you upon receipt of payment from your insurance company. If we are not a direct repair facility for your insurance; please note our rates at the front desk and you hereby acknowledge that you are responsible for any overages your insurance does not cover.

I hereby authorize the repair work hereinafter set forth to be done along with the necessary material and agree that Performance Collision Centers are not responsible for loss or damage to the vehicle or articles left in case of fire, theft or any other cause beyond your control or for any delays caused by unavailability of parts or delays in part shipments by the supplier or transporter. I hereby grant you and/or your employees’ permission to operate the vehicle herein describe on streets, highways or elsewhere for the purpose of testing and/or inspection. An express mechanic’s lien is hereby acknowledged on vehicle to secure the number of repairs thereto.