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Repair Authorization Form

I hereby authorize Vision Collision Center LLC dba 14/69 Auto Body to perform all necessary repairs to my vehicle as estimated. I understand that payment in full will be due upon release of the vehicle, including any deductible storage fees responsibility and betterment which may have been applied, also any additional supplemental damage charges not covered by an insurance claim. I hereby grant Vision Collision Center LLC dba 14/69 Auto Body and its employees, permission to operate the vehicle herein described streets, highways or elsewhere for the purpose of testing and or inspection. An express mechanic’s lien is hereby acknowledged on the vehicle to secure the amount of the repairs thereto. Vision Collision will not be held responsible for loss or damage to vehicle or articles left in the vehicle in case of fire, theft, accident or any other cause beyond our control.

Parts removed from your vehicle will be disposed of unless otherwise instructed.

I authorize payment and supplement payable to Vision Collision Centers LLC and or 14/69 Auto Body.

I authorize Vision Collision Center LLC dba 14/69 Auto Body to share, if necessary, vehicle scan data to a third party directly involved in the vehicle claim and or repair process.

In signing I am also invoking Vision Collision Center LLC dba 14/69 Auto Body right to use my signature as of power of attorney to sign insurance checks to pay for the damages to above vehicle.

  • The authorization code must be provided by a 14/69 Auto Body representative. If you don't have a code contact us at 260-225-4071.

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