Blank Repair Authorization 7.2020 (1)

NAME: ________________________________________DATE: _____________ TIME: ____________ ADDR: ______________________________________HOME PH: ____________________________ CITY: ________________ ST: ______ZIP: ________CELL PH: _____________________________ EMAIL: ________________________________________ PREFERRED METHOD OF SECONDARY CONTACT:CALL❑EMAIL❑TEXT❑ AREA OF DAMAGE:__________________________________________________________________ SPECIAL REQUESTS, INSTRUCTIONS OR CONCERNS: ____________________________________ _____________________________________________________________________________________ YEAR________ MAKE________________ MODEL___________________ COLOR _____________ INSURANCE COMPANY PAYING FOR REPAIR: _____________________________ CLAIM NO: ________________________________ ADJUSTER: _______________________ PHONE: _______________ESTIMATED YET?Y❑N❑ HAVE YOU RECEIVED ANY PAYMENTS FOR THIS REPAIR?Y❑N❑AMOUNT? ______________ AUTHORIZATION FOR ESTIMATE/ REPAIRS I understand that Joe Myers Ford is not responsible for the loss or damage to the vehicle in case of fire, theft or causes beyond their control. Joe Myers Ford will not be held responsible for any delays caused by the availability of parts, or insurance company. Target dates are goals for completion and not guaranteed.Parts prices quoted are subject to invoicing and may change. Larger repairs may take over 30 days to complete and I may need to make arrangements for alternate transportation in the event rental coverage is not sufficient. Any vehicle not repaired, totaled or abandoned will be subject to storage, administrative, towing, transfer or other fees. This document will also serve as a"Power of Attorney"for endorsements of any and all payments for repairs, and redirection of all supplemental payments associated with the repairs of this vehicle referenced here. I also authorize all payments to be directed toJOE MYERS FORDfor all related or supplemental repairs in the above referenced repair / claim, less any deductibles that may apply. I herby authorize the repair work herein set forth to be performed with the necessary materials. I give permission for Joe Myers Ford to operate the vehicle described herein on streets, highways, or elsewhere for the purpose of testing and/or inspection. SIGNATURE:________________________________DATE:___________________ BY SIGNING BELOWI FURTHER ACKNOWLEDGE AND AGREE THAT IF ANY CHECK TENDERED IN PAYMENT FOR REPAIRS IS RETURNED FOR ANY REASON, OR IF ANY CREDIT CARD PAYMENT FOR REPAIRS IS STOPPED DUE TO CLOSED OR NO ACCOUNT THEN THIS SHOP MAY REPOSSESS THE VEHICLE IN ACCORDANCE WITH§70.001,TEXASPROPERTYCODE.I N SUCH AN EVENT THE VEHICLE OWNER IS RESPONSIBLE FOR ALL REASONABLE CHARGES ASSOCIATED WITH THE REPOSSESSION . SIGNATURE:DATE: Initials below indicate that I acknowledge that I have been advised toremove all valuablesand Joe Myers Ford is not responsible for contents.