repair authorization form

Vehicle Owner Name:*
Contact*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
I authorize _____DUKE COLLISION______ to repair my vehicle.
Year: Make Model Color
VIN
Vehicle Owner’s Initials
Date
Date Format: DD slash MM slash YYYY
Vehicle Owner’s Signature
Do you need courtesy car?*
- Yes
- No
Terms and condition*
Accept
We Duke Collision, certify that the vehicle will be repaired to its Pre Accident condition of safety, function, and appearance. NOTE-IF VEHICLE IS NOT PICKED UP WITHING 24 HOURS OF COMPLETION; AFTER NOTIFIED BY TEXT/ CALL/ EMAIL; A STORAGE FEE OF $25.00/DAY WILL BE ADDED TO TOTAL AMOUNT.
Name
This field is for validation purposes and should be left unchanged.

REPAIR AUTHORIZATION FORM