Legally Binding Repair Authorization and Consent

This document serves as a formal and legally binding agreement between and the undersigned customer. By affixing your digital signature, you acknowledge your consent to the outlined repair services, terms, and conditions, and agree to comply with all relevant legal requirements. Please read carefully before proceeding.

Your Details:

Vehicle Details:

Insurance Information: (Required if using Insurance)

PLEASE READ CAREFULLY, CHECK ONE OF THE STATEMENTS BELOW, AND SIGN:

I UNDERSTAND THAT, UNDER STATE LAW, I AM ENTITLED TO A WRITTEN ESTIMATE IF MY FINAL BILL WILL EXCEED $100.

I DO NOT REQUEST A WRITTEN ESTIMATE AS LONG AS THE REPAIR COSTS DO NOT EXCEED $
THE SHOP MAY NOT EXCEED THIS AMOUNT WITHOUT MY WRITTEN OR ORAL APPROVAL.

COMPANY INVOICE

MV:

MVR:

Address:

Phone Number:

  • *U/Used
  • R/Repaired
  • A/Aftermarket
  • S/Straightened
  • M/Manufactured Part

LABOR HOURS

  • QTY
  • *
  • Part No.
  • Description
    CUSTOMER COMPLAINT/PROBLEM CLAIM #
  • Body
  • Paint
  • Frame
  • Mech

All parts and labor are warrantied for months/ miles unless otherwise stated.

Vehicle Information

  • Save Parts:

    No

  • Core may apply:

    Yes

Charges based on:

  • Hourly Rate
  • Flat Rate
  • Both Apply

Estimate Diagnosis:

  • Fee: $ or
  • Hourly at $ /hr.

Payment Method:

  • Cash
  • Check
  • Visa
  • MC
  • Amex

Estimated Cost: $

**This charge represents costs and profits to the motor vehicle repair facility for miscellaneous shop supplies or waste disposal.

***s. 403.718, F.S. mandates a $1.50 fee for each new or manufactured battery sold in the State of Florida.

Estimate good for 30 days. The facility is not responsible for damage caused by theft, fire, or acts of nature. I authorize the above repairs to my vehicle including the necessary materials and sublet work. You and your employees may operate my vehicle for the purpose of testing, inspection, and delivery at my risk. If I cancel repairs to my vehicle for any reason, I understand that a tear-down and reassemble fees of $ will apply. I understand that a charge of $ per day will be charged if I fail to pick up my vehicle within (3) working days of notification of completion.

  • Body Hours/@ Paint Hours/@ Mech Hours/@ Paint Supplies Body Supplies Tow Storage Epa/Waste Miscellaneous
  • $
  • Parts: Labor: **Shop Sup: Sublet: ***Fees: Subtotal: Tax: Total:
  • $ $ $ $ $ $ $ $
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Repair Agreement

DEFAULT_REPAIR_AGREEMENT

Direction to pay

DEFAULT_DIRECTION_TO_PAY

Consent to Electronic Communications & Electronic Signatures

I authorize to contact me about my repair via phone, email, or text message and agree to any data rates that may apply. You may opt-out of communications at any time.

The customer and agree that this Authorization Form may be executed and delivered by electronic signatures, in accordance with the Electronic Signatures in Global and National Commerce Act (ESIGN Act) and the Uniform Electronic Transactions Act (UETA). Both parties acknowledge that the signature appearing on this Authorization Form, whether electronic or manual, has the same force and effect and is the legal equivalent of your manual signature, as provided by the ESIGN Act and UETA.

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No Agreement Terms Available

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