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Run: Repair Authorization and Direction to Pay Form

A repair authorization and direction to pay form for collision shops to confirm approved work, teardown consent, and insurance payment routing before repairs...

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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. (required)

Yes No N/A

Customer and Vehicle Details

Customer full name (required)

Customer phone number (required)

Customer email address

Vehicle year (required)

Vehicle make (required)

Vehicle model (required)

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 (required)

Repair Authorization

Work authorized (required)

I authorize the shop to begin the approved repair work on my vehicle. (required)

Yes No N/A

I authorize teardown/disassembly as needed to inspect for hidden damage and prepare supplements. (required)

Yes No N/A

If hidden damage is discovered, I authorize the shop to document it and request additional approval before proceeding beyond the approved amount. (required)

Yes No N/A

Insurance and Direction to Pay

Is an insurance claim involved? (required)

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.

Yes No N/A

Customer Attestation and Signature

I confirm I am the vehicle owner or an authorized representative with authority to approve this work. (required)

Yes No N/A

Date signed (required)

Customer signature (required)

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