Repair Authorization Form. Please enter fields below to authorize repairs.


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Name:*  
Address:* City:*
State:*           Zip:* Vehicle Description:*
    
Who Pays :* Customer Initials:*
Customer        Insurance
Instructions
Cash, Money Order, or Cashier's Check. Insurance Check or Payment Check. Personal Check, and subject to check guarantee Visa, Mastercard, or Discover. All deductibles, customer-paid repairs, betterment, and insurance repairs must be paid in full by the following means: Any supplements that are left open on your account will be billed to your insurance company. A Mechanic's lien will remain in place until the account is paid in full.

We appreciate your selection of our business to serve your auto body repair needs. Your regard and trust is important to us and we will try to always provide you with personal, sincere, and professional care. Please feel free to call us whenever you have any questions regarding your automobile. Authorized and Accepted: You, Capital City Collision, are hereby authorized to make the specified repairs. You will not be held responsible for loss or damage to vehicle or articles left in vehicle in case or fire, theft, accident, or any other causes beyond your control. The above report is based on our inspection and does not cover additional parts or labor which may be required after the work has been opened up. Occasionally after the work has been started, damaged or broken down parts are discovered which are not evident on the first inspection. Because of this, above prices cannot be guaranteed. This estimate is for immediate acceptance only.

Comments:  
Signature:* (Enter name to verify signature) Date:*
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