Repair Authorization and Direction to Pay Form

Estimator authorization form for collision repair customers to consent to repair, teardown, and disassembly, and to direct insurance proceeds to the repair facility.

Submission Notice

• What happens after I submit?
  Your authorization will be added to the repair record as part of the audit trail. The shop may begin approved repair and teardown work, and will contact you if additional hidden damage requires further approval.
• I understand this form authorizes repair, teardown/disassembly as needed to inspect hidden damage, and direction to pay if applicable.

Customer and Vehicle Details

• Customer full name
• Customer phone number
• Customer email address
• Vehicle year
• Vehicle make
• Vehicle model
• Vehicle identification number (VIN)
  Optional unless needed to match the repair order. Do not collect if the repair file already has the VIN.
• Repair order number

Repair Authorization

• Work authorized
• I authorize the shop to begin the approved repair work on my vehicle.
• I authorize teardown/disassembly as needed to inspect for hidden damage and prepare supplements.
• If hidden damage is discovered, I authorize the shop to document it and request additional approval before proceeding beyond the approved amount.

Insurance and Direction to Pay

• Is an insurance claim involved?
• Insurance company name
• Claim number
• Direction to pay / assignment of insurance proceeds
  Check this only if you authorize the insurer to pay the repair facility directly, to the extent allowed by your policy and applicable law.

Customer Attestation and Signature

• I confirm I am the vehicle owner or an authorized representative with authority to approve this work.
• Date signed
• Customer signature