VP AUTO COLLISION WORK AUTHORIZATION FORM
Name*
Home Phone:
Cell Phone:
Address:
Email*
City
State:
Zipcode:
Vehicle Year:*
Make:*
Model*:
Vehicle Vin:
Insurance Company*:
Claim #*:
How Can We Contact You?
By Text? YesNo
By Email? YesNo
Work Authorization
I hereby authorize the repair work that has been explained to me to be done along with the necessary materials. I agree that VP Auto Collision is not responsible for loss or damage to my vehicle or articles left in case of fire, theft, or any other cause beyond VP's control; or for any delays caused by unavailability of parts or delay in parts shipments by the supplier or transporter. I hereby grant you and/or your employees' permission to operate the vehicle herein described on street, highway, or elsewhere for the purpose of testing and/or inspection. An express mechanic's lien is hereby acknowledged on the vehicle to secure the amount of repairs thereto.
Direction of Pay
I authorize the insurance company listed above to pay VP Auto Collision directly for repairs to my vehicle and grant VP Auto Collision power of attorney to receive and deposit any payments related to this claim.
Accepted By:*
Date:*
BY CLICKING SUBMIT I AM DIGITALLY SIGNING THIS FORM AND GIVING AUTHORIZATION AND POWER OF ATTORNEY TO VP AUTO COLLISION AS STATED FORTH IN THIS DOCUMENT.
