Authorization Form

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This field is for validation purposes and should be left unchanged.

General Information

Name(Required)

Email(Required)

Phone(Required)

Your Vehicle's Information

License Plate # or Last 8 of VIN:(Required)

Year/Make/ Model(Required)

Repair Authorization & Terms

T&C(Required)

I hereby authorize the repairs outlined above to be performed on my vehicle. I understand that full payment is due upon release of the vehicle, including any additional charges resulting from supplemental damage discovered during the repair process. If I choose to cancel repairs after parts have been ordered, I agree to pay any applicable restocking fees associated with returning those parts. I grant permission to Bumper to Bumper Body & Paint and its employees to operate the vehicle on public roads or elsewhere as necessary for testing, inspection, or quality control purposes. I acknowledge and grant an express mechanic’s lien on the vehicle to secure payment for all repairs performed. Bumper to Bumper Body & Paint is not responsible for loss of or damage to the vehicle or any personal items left inside due to fire, theft, accident, or any other cause beyond our control. Unless otherwise requested in writing, all parts removed from the vehicle will be discarded. If an insurance carrier is paying for all or part of my repair order, I authorize payment to Bumper to Bumper Body & Paint. If a deductible is required, I will be responsible for payment. Furthermore, I authorize any and all supplement repair order amounts to be paid to Bumper to Bumper Body & Paint.

Electronic Signature:(Required)

Date

Authorization Form

First-Class Collision Repair