Repair Autorization

*****PARTS PRICES SUBJECT TO INVOICE***AUTHORIZED AND ACCEPTED:

You are hereby authorized to make the specified repairs to my vehicle. I understand that payment in full will be due upon release of vehicle, including additional supplemental damage charges, and hereby grant you and/or your employees, permission to operate the vehicle herein described on streets, highways or elsewhere for the purpose of testing and/or inspection. An express mechanic’s lien is hereby acknowledged on above vehicle to secure the amount of repairs thereto. You will not be held responsible for loss or damage to vehicle or articles left in vehicle in case of fire, theft, accident or any other cause beyond your control. Old parts removed from vehicle will be junked unless otherwise instructed! I authorize any and all supplements payable direct to you. I authorize you to act as power of attorney to sign insurance checks to pay for damages to the above vehicle.

Customer Name:
Phone:
Date:
Repair Order # :
Vehicle License #:
Vehicle Make / Model: :

By submitting this form you agree to the terms and conditions above