Completion and Direction to Pay

Performance Collision – Morgantown, WV

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VEHICLE OWNER’S NAME*
VEHICLE OWNER’S EMAIL*
VEHICLE YEAR*
VEHICLE MAKE*
VEHICLE MODEL*
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*
Date Format: MM slash DD slash YYYY