The following questions are being asked with the intention of making sure the repair process and delivery of the completed vehicle go as smoothly as possible.
Standard Authorization/Power of Attorney
Estimates of repairs include all known parts, labor handling and diagnosis; on closer analysis additional repairs may be necessary. If applicable, I authorize Burl's Collision Center to act as my agent in negotiating the final cost of repairs with my insurance company. I hereby authorize the repair work described herein to be performed, including sublet work, and grant you or your employees permission to operate the vehicle on streets or highways for the purpose of repairing or testing, and acknowledge receipt of this estimate. Burl's Collision Center shall not be liable for any items left in vehicle. This includes but is not limited to, any aftermarket audio equipment. I understand that I am responsible for payment of the cost of the said repairs and agree that in the event legal action is required I will also pay such additional amount as the court may fix as attorney fees. If an insurance claim, the undersigned does hereby constitute and appoint Burl's Collision Center my true and lawful attorney to sign my name on any insurance drafts covering any authorized repairs to my automobile and to take such action as may be necessary to negotiate said drafts.
Authorization Form & Direction of Pay
I hereby authorize Burl's Collision Center to make specified repairs. I understand that full payment will be due upon release of the vehicle, including additional supplemental damage charges. I hereby grant Burl's Collision Center employees permission to operate the vehicle on streets, highways or elsewhere for the purposes of testing and/or inspection. An express mechanics lien is hereby acknowledged on the vehicle to secure the number of repairs thereto.
Burl's Collision Center will dispose of old parts removed from the vehicle unless otherwise instructed. Burl's Collision Center will not be held liable for loss or damage to vehicle or articles left in the vehicle in the case of fire, theft, accident, or any other cause not due to the negligence of Burl's Collision Center or its employees.
Power of Attorney
I do herby appoint Burl's Collision Center to act as power of attorney in fact to accept on my behalf all checks, drafts, or bills of exchange, and to endorse all such checks, drafts, bills of exchange for deposit to Burl's Collision Center account for credit on my account for repairs to my vehicle. I authorize any and all supplemental charges to be made payable to Burl's Collision Center.
Vehicle Release Policy
CUSTOMER SAFETY INSPECTION INFORMATION:In order to verify the vehicle is safe and continues to perform the same in subsequent accidents, please provide the information below.