ORLANDO BODY REPAIR AUTHORIZATION FORM



    Repair Location*:





    Work Authorization

    In accordance with the attached repair estimate, I hereby authorize repair work to be done on the above vehicle using whatever materials Orlando Auto Body, Inc. deems necessary. I acknowledge that the estimate is based upon a surface inspection and does not cover any additional parts or labor that may be discovered to be necessary after the job as begun, therefore I understand that the estimate price may be subject to supplementation. Additionally, I hereby grant Orlando Auto Body, Inc. and its employees permission to operate the vehicle on streets and elsewhere for the purpose of testing and/or inspection. I will not hold Orlando Auto Body, Inc. responsible for loss or damage to articles left in my vehicle in case of fire, theft, or any other causes beyond their control.

    I hereby designate Orlando Auto Body, Inc. as my sole authorized representative for the settlement of any insurance claims regarding the repair of this vehicle and authorize this representative to negotiate with the insurance adjuster assigned to this claim for the safe restoration of my vehicle. I authorize and grant to Orlando Auto Body, Inc. and its management a power of attorney (POA) to sign any insurance draft and any other instruments used for the payment of repair for this vehicle.

    I acknowledge that Orlando Auto Body, Inc. has an express mechanics lien on the vehicle to secure payment of the amount of repairs thereto, for storage fees, and for related costs and fees as more fully set forth below. I authorize Orlando Auto Body, Inc. to retain possession of the vehicle until such time as all indebtedness is paid or otherwise provided for.

    While Orlando Auto Body, Inc. shall endeavor to seek payment for the work from insurance, whether my own or that of a responsible third party, I acknowledge that I assume full responsibility for all work performed. I acknowledge that Orlando Auto Body, Inc.’s efforts to obtain compensation from insurance is done as a benefit to me and that it is under no obligation to do so, and in the event that Orlando Auto Body, Inc. cannot obtain full and complete payment from insurance, I will remain responsible to Orlando Auto Body, Inc. for any unpaid sums. In the event that I and/or the insurance decide not to pursue repair, or in the event of any delay in approval by insurance, I will be responsible to pay storage fees at the daily rate set forth on the repair estimate(s) and supplement(s).

    Additionally, I shall remain responsible for any fees and costs incurred by Orlando Auto Body, Inc. to obtain full payment for all services rendered, parts provided, storage fees, title and auction fees and costs related to lien enforcement, and to any and all attorney, collection, and legal fees incurred in obtaining payment for the work performed, whether or not a lawsuit is filed. Should Orlando Auto Body, Inc. exercise its lien rights, the proceeds from the sale of my vehicle will be applied to offset the total balance owed. Any excess proceeds will be paid first to any other lienholder and then any remaining balance to me. If the sales proceeds are insufficient to pay the full balance owed, I understand that Orlando Auto Body, Inc. shall have the right to seek payment from me of the remaining balance due. Orlando Auto Body, Inc. shall be entitled to interest on any unpaid balance due at the rate of 18% per annum beginning 30 days after the due date







    BY CLICKING SUBMIT I AM DIGITALLY SIGNING THIS FORM AND GIVING AUTHORIZATION AND POWER OF ATTORNEY TO ORLANDO AUTO BODY AS STATED FORTH IN THIS DOCUMENT.