Serving You At Two Locations

Authorization Forms

Authorization & Direction to Pay

This form allows payment from the insurance company to be issued directly to the shop. Also understand this DTP is required so that your vehicle may be released upon completion of repairs.

Customer Name
Fred Anderson Collision will not be responsible for any theft or damage to any valuables left in your vehicle while your vehicle is on the premises.
Payment Policy
Upon completion of repairs, any deductible, betterment or customer pay items must be paid in full. The vehicle will not be released until payment is received or arrangements have been made with the primary payee. It is the customer’s responsibility to secure 3rd pay endorsements (insurance checks can be endorsed by all parties directly to the repair center).
Work Authorization
1. I hereby authorize the repair work set forth to be done, along with the necessary parts and materials. The estimate to repair includes parts, labor and diagnostics. Upon further inspection, if additional repairs are needed, the primary payee will be contacted. 2. I understand that the repair center is not responsible for loss or damage to the vehicle or articles left in the vehicle in the case of fire, theft, accident or anything beyond their control. 3. I hereby grant your employees permission to operate my vehicle for the purpose of inspection on the streets, highway or elsewhere. 4. I understand that if a 3rd party provides a replacement vehicle, the repair center is not responsible for costs, damages or any liability. 5.POWER OF ATTORNEY: I authorize and appoint FRED ANDERSON COLLISION as my attorney-in-fact to endorse my name on and cash any insurance check payable to me for repairs. I authorize any and all supplements payable directly to FRED ANDERSON COLLISION. 6. Delivery dates given are approximate and will change if additional parts or repairs are needed. We will contact you if the delivery date originally quoted needs to be adjusted for any reason. 7. I understand and agree that I am responsible for paying all amounts due for repair work (including parts, labor and diagnostics) not otherwise paid by the insurance company or another party. I agree that I will notify FRED ANDERSON COLLISION if I have received payment from an insurance carrier or another party for the repairs prior to the date that I take delivery of the vehicle. I further agree that I am responsible for paying FRED ANDERSON COLLISION all amounts received from an insurance carrier or other party for the repairs of the vehicle. 8. Provider agrees to secure vehicle owner’s written consent to extract data that is stored in the vehicle, including its event data recorder, prior to conducting any scanning or diagnostics operation. Provider agrees that access to such data will be for the limited purpose of conducting vehicle diagnostics and/or repairs.
MM slash DD slash YYYY

Vehicle Release Authorization

This form gives permission from the vehicle owner for another person to pick up their vehicle

authorize FRED ANDERSON COLLISION to release my
All personal belongings and license plate have been removed from the vehicle.
MM slash DD slash YYYY
MM slash DD slash YYYY