AUTHORIZATION AND DIRECTION TO PAY
(You have the right to select any repair facility to repair your vehicle)
Vehicle Owner’s Name: __________________________________________
Vehicle Description: ______________________________________________
Year Make Model VIN#
Claim Number: _______________________ Date of Loss: ________________
I authorize(d) Neil Tapp’s Auto Collision Center to estimate and repair my vehicle, unless it is an economic total loss.
___________________________________ |
______________ |
(Vehicle Owner’s Signature) |
(Date) |
I have received a copy of the initial and final automated repair estimate.
I authorize____________(insurance company) to pay Neil Tapp’s Auto Collision Center
$____________ on my behalf.
____________________________________ |
________________ |
(Vehicle Owner’s Signature) |
(Date) |
I certify that repairs have been completed as indicated on the final automated repair estimate.
____________________________________ |
___________________ |
(Repairer’s Signature) |
(Date) |
*Form must be retained in repairer’s records for at least 6 months, or longer if required by state law.