Authorization and Direction to Pay

Click here to download the PDF version of the Authorization and Direction to Pay form.

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  • I AGREE THAT PERFORMANCE AUTO BODY LLC WILL NOT BE HELD RESPONSIBLE FOR ANY RENTAL VEHICLE BILLS FOR ANY REASON!!

    I AUTHORIZE PERFORMANCE AUTO BODY LLC TO ESTIMATE AND REPAIR MY VEHICLE,UNLESS IT IS AN ECONOMIC TOTAL LOSS

    I AUTHORIZE INSURANCE COMPANY TO PAY SUPPLEMENT DIRECT TO PERFORMANCE AUTO BODY LLC WITH THE UNDERSTANDING THAT I WILL BE OBLIGATED FOR PAYMENT IF IT EXCEEDS 30 DAYS FROM BEING SUBMITTED

    I ACCEPT TERMS OF DEDUCTIBLE OR BETTERMENTS MUST BE SATISFIED AND DIRECTION OF PAY MUST BE SIGNED BEFORE VEHICLE IS TO BE RELEASED
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  • I CERTIFY THAT REPAIRS HAVE BEEN COMPLETED AS INDICATED ON FINAL ESTIMATE AND RE AUTHORIZE DIRECT PAYMENT OF SUPPLEMENT TO PERFORMANCE AUTO BODY LLC WITH THE UNDERSTANDING THAT I WILL BE OBLIGATED FOR PAYMENT IF IT EXCEEDS 30 DAYS FROM BEING SUBMITTED
  • Date Format: MM slash DD slash YYYY