Authorization and Direction to Pay | Morgantown, WV | Parsons, WV

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VEHICLE OWNER’S NAME*

VEHICLE OWNER’S EMAIL*

VEHICLE YEAR*

VEHICLE MAKE*

VEHICLE MODEL*

VIN

CLAIM #

DATE OF LOSS*

Deductible Amount

Insurance Company*

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

Vehicle Owner*

Date*

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

Vehicle Owner*

Date*