Work Authorization Form

I agree

I warrant and represent that I am the owner of the above described vehicle (hereinafter “the vehicle”) or an authorized agent of the owner. As the owner or agent, I authorize Mobility Collision Centers to repair the vehicle and provide the necessary services, parts, and materials needed to complete the repair. I further authorize employees of Mobility Collision Centers and its vendors involved in the repair to operate the vehicle on streets and elsewhere for the purpose of testing and/or inspection. I acknowledge and understand that Mobility Collision Centers will have an express mechanics lien on and a security interest in the vehicle until such time as all indebtedness is paid in full. I further agree that Mobility Collision Centers shall not be responsible for loss or damage to articles left in the vehicle in case of fire, theft or any other cause. I further authorize Mobility Collision Centers to be my representative to negotiate with any insurance company/representative regarding the restoration of the vehicle to pre-accident condition and value. Mobility Collision Centers is authorized to endorse drafts from insurance company securing payment.*

I agree

Owner/Agent acknowledges payment in the form of Cash, Cashier’s Check, Debit, Visa, Master Card, or Discover. No other forms of payment will be accepted.*

I agree

Owner/Agent agrees that Mobility Collision Centers will not be held responsible for loss or damage of articles left in the vehicle. Owner/Agent further agrees that Mobility Collision Centers is not responsible for window tint, glass breakage or damage due to removal or work being performed on the vehicle.*

I agree

Owner/Agent acknowledges and understands that payment of insurance deductible is due to Mobility Collision Centers prior to release of the vehicle.*

I agree

Owner/Agent acknowledges and understands that all vehicles left over ten (10) days after scheduled pick-up date will incur a $30.00 per day storage fee. All work left over thirty (30) days will be subject to foreclosure of Mobility Collision Centers Mechanics lien.*