Authorization Form

NOTICE TO CUSTOMERS: There are no laws in the Commonwealth of Virginia that require you to obtain more than one written estimate to repair your damaged vehicle.

*First Name

*Last Name

*Phone

*Email

Address

Comments

Year

Make

Model

Preferred Method of Contact

Claim Number

Accident Related Damage

Pre Existing Damage Not Accident Related

AUTHORIZATION: With my signature below. I give Huber Collision Center permission to estimate the cost to repair the damage to my vehicle. In addition, I understand that the extent of the damage may not be fully disclosed until such time as my vehicle is disassembled.

Please select the Check box and Type in your name. This gives Huber Collision Center permission to estimate the cost to repair the damage to my vehicle.

Date

Estimates and Repairs - I hereby authorize Huber Collision Center to provide an estimate to repair my vehicle and, unless the vehicle is declared a total loss, to perform the identified services required to repair the subject vehicle.

Personal Check Policy - I have been advised and understand that Huber Collision Center cannot accept any personal check in excess of $250.00.

Storage Fee Policy - I have been advised and understand that a storage fee in the amount of $85.00 per calendar day will be assessed if my vehicle if my vehicle is not picked up within 48 hours of being notified that the contracted work has been completed and the vehicle is ready for delivery. I further understand that the storage fee policy is different when a vehicle has been declared a total loss and is handled on a case-by-case basis.

Authorized by:

Date

Power Of Attorney

If this repair is subject to an insurance claim and related payments, the undersigned does hereby constitute and appoint Huber Collision Center as lawful attorney to sign my name to any and all insurance drafts issue to cover the cost of my repairs.

In the event that a check from the insurance company for all, or a portion, of the damages to my vehicle is mailed to my home address I will notify Huber Collision Center and delivery said document to them for payment processing against my account.

Authorized by:

Date

Huber Collision Center

Authorization Form

Huber Collision Center

NOTICE TO CUSTOMERS: There are no laws in the Commonwealth of Virginia that require you to obtain more than one written estimate to repair your damaged vehicle.

Insurance Provider

Please Note We do not accept personal checks in excess of $250.00

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Huber Collision Center

A Huber Motor Cars Company

Collision and Mechanical Repair Authorization

CERTIFICATIONS:

Power Of Attorney