Repair Authorization Insurance Company(Required) Claim Number(Required) Vehicle Make(Required) Vehicle Model(Required) Vehicle Year(Required) VIN(Required) Estimates performed prior to disassembly of a vehicle are not accurate due to the probability of hidden damage. Therefore, it is our practice that accurate estimates of the cost to repair and the expected time to complete repairs, are not made until we have disassembled the area of damage to your vehicle. Be aware, Smitty’s Maintenance Repair & Collision, Inc. labor rates are posted in the collision office. Smitty’s will review all insurance estimates for an acceptable labor rate and parts replacement. If the insurance estimate is not accepted you may or we may contact the insurance company to discuss the labor rate and parts replacement. If Smitty’s and the insurance company cannot agree on an accepted labor rate, the customer will be responsible for any differences. As well as the parts, there are instances when the insurance company expects Smitty’s to purchase parts outside of our normal vendor accounts. We will make the effort to make the purchases requested by your insurance company however some parts may no longer be available or they may be inferior parts below our standard of quality. Smitty’s will do everything within our limits to work with your insurance company however it is our warranty for the work performed “NOT THE INSURANCE COMPANIES”. We take pride in the quality, service and safety that we provide to you as our customer.CANCELLATION FEES(Required) I agree to all Cancellation fees necessary Once the repair authorization is complete by customer, parts will be ordered per the estimate. In the event that Smitty’s does not repair your vehicle, there will be a estimate fee, fee for administrative time to process vehicle prior to repair, any labor performed in regards to disassembling and estimating the damage, parts, restocking fees for parts and materials, storage for the time the vehicle was in our possession, and any other fees reasonably incurred by Smitty’s related to your vehicle.TEMPORARY REPAIRS(Required) I agree to pay the deposit in case temporary repairs are necessaryIn the event we are able to attempt a temporary repair to vehicle that could allow customer to drive vehicle until full repairs can be completed, Smitty’s does charge a deposit for the temporary repair which could be either the insurance payment if available, customer deductible, or an amount to be determined based on the temporary repair to be completed. The deposit will be applied towards total amount of the repair.Credit Card Convenience Fee(Required) I agree to the Credit Card Convenience Fee. A 3% Convenience Fee will be added to all payments made by credit card. This fee will be due at the time of credit card payment and is non-refundable.(Required)Payment Timeline(Required) I understand Personal and Business Check payments are accepted only if received at least 14 days prior to repair completion.(Required)Returned Checks Agreement(Required) I understand if a check payment is returned unpaid, I agree to make full payment and pay a $30 return check fee within 24 hours from the date of notification payable by Cash only.(Required)ALL CUSTOMER PORTION OF VEHICLE REPAIR MUST BE PAID IN FULL OR THE VEHICLE WILL NOT BE RELEASED AND/OR WE MUST HAVE A PROOF OF PAYMENT FROM INSURANCE TO PAY US DIRECTLY. YOU AUTHORIZE SMITTY’S MAINTENANCE REPAIR & COLLISION AS POWER OF ATTORNEY TO ENDORSE YOUR NAME ON ANY INSURANCE CHECK FOR THE PURPOSE OF PAYING FOR REPAIRS TO YOUR VEHICLE. ANY THIRD-PARTY PAYMENTS MUST BE PAID IN FULL PRIOR TO VEHICLE REPAIRS AND DELIVERY FOR ANY ADDITIONAL REPAIR. The insurance company may have already sent the original estimate check for payment towards my vehicle repair. Any check that I receive is to be given to Smitty’s Maintenance Repair & Collision. I also acknowledge that Smitty’s Maintenance Repair & Collision must verify payment prior to releasing the repaired vehicle. If Smitty’s is unable to verify payment, it is the responsibility of the vehicle owner to pay for repairs and will be reimbursed upon receipt of payment from the insurance company. If we are not a direct repair for the insurance company, please note our rates and vehicle owner hereby acknowledges the financial responsibility for any overages the insurance company does not cover. In some cases, your assistance may be required by following up with the insurance company to make sure they make timely payments. In the event an insurance company is not responding to our submission for supplements and/or payments we will require the customer to follow up with the insurance company. Employees of Smitty’s and its sublet vendors may occasionally operate your vehicle for testing, moving, or pickup/delivery purposes. During the process of repair, it is normal for the battery to be disconnected which may result in memory presets.Acknowledgement and Authorization(Required) I have read the above paragraphs and I hereby authorize the repair to the above referenced vehicle as described in the estimate and acknowledge that I understand all of the above.(Required)Waiver of Liability(Required) I understand that Smitty’s is not responsible for the security or condition of any personal property left in the vehicle. An express mechanics lien is hereby acknowledged on this vehicle to secure the amount of repair thereto.(Required)Name(Required) First Last Date(Required) MM slash DD slash YYYY Signature(Required) Reset signature Signature locked. Reset to sign again CommentsThis field is for validation purposes and should be left unchanged. Δ
