Athans Work Authorization Form

DATE: (required)

YOUR NAME: (required)

YOUR EMAIL (required)

Best PHONE NUMBER To Reach You: (required)

YOUR ADDRESS: (required)

YOUR CITY and STATE: (required)

YOUR ZIP CODE (required)

VEHICLE YEAR, MAKE, and MODEL (required)

WHO IS PAYING FOR YOUR REPAIRS? (required)
InsuranceCustomer3rd Party

INURANCE COMPANY:

YOUR CLAIM NUMBER:

YOUR DEDUCTIBLE AMOUNT:

YOUR ADJUTER'S NAME:

YOUR ADJUTER'S PHONE:

I authorize tear down and appraisal of vehicle. If vehicle is not repaired by Athans Auto Body I understand there will be a charge not to exceed $500 for the estimate., tear-down, and negotiation performed. Cash, cashier's check or money order only. No reassembly of vehicle will be performed due to nature of damages.
I hereby authorize the above repair work to be done along with necessary materials. You and your employees may operate the above vehicle for purpose of testing, inspection, or delivery at my risk. An express mechanic's lien is acknowledged on the above vehicle to secure the amount of repairs thereto. Body shop will not be held responsible for loss or damage to vehicle or articles left in vehicle in case of fire, theft, accident or any other cause beyond our control. STORAGE WILL NE CHARGED FORTY-EIGHT (48) HOURS AFTER REPAIRS ARE COMPLETED. IN THE EVENT LEGAL ACTION IS NECESSARY TO ENFORCE THIS CONTRACT. I WILL PAY REASONABLE ATTORNEY'S FEES AND COURT COSTS. We constitute and appoint Athans Auto Body our true lawful attorney to sign our name, place, and stead of the undersigned on any insurance drafts issued by our insurance company covering any repair to our automobile authorized by ourselves in whatever manner necessary to place check or draft in a cashable position. The undersigned understands if Athans Auto Body is waiting on undersigned's insurance companies estimate will repair automobile to that said estimate.