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Repair Authorization

By submitting this form I hereby authorize repair of my vehicle. I understand that Pompey Collision and AutoBody is not responsible for articles left in the vehicle that are lost or damaged due to causes beyond their control. I understand Pompey Collision and AutoBody cannot guarantee an exact delivery date. These dates are estimates only and Pompey Collision and AutoBody is NOT responsible for delays caused by unavailability of parts or delays due to hidden damage. I also hereby grant permission to Pompey Collision and AutoBody, it's employees and any subcontractor (used by Pompey Collision and AutoBody) to operate the above vehicle for purpose of testing/or inspecting.The total amount of the repair charges must be paid before the vehicle can be released. The deductable must be paid before the vehicle can be released. I also understand that the cost to repair my vehicle may exceed the amount the insurance company has agreed to pay and that I assume all responsibility of costs exceeding that dollar amount. I also understand that some parts are not returnable or may require a restocking fee, and if that is so, I assume all of those costs should my vehicle not be repaired for some reason. I hereby assign Pompey Collision and AutoBody the right to collect and retain any and all amounts required to repair my vehicle, including but not limited to amounts due for labor rate discrepancies, parts price discrepancies and repair procedures from the insurance company responsible. This includes collections and deposits of checks made out directly to Pompey Collision and AutoBody and checks made jointly to Pompey Collision and AutoBody and claimant or insured for my vehicle.

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