Please fill in all information pertaining to the primary point of contact handling the repairs on the vehicle being left for repairs.

    Work Authorization:
    I hereby authorize the repair of the vehicle identified above by the Chantilly Auto Body Group (Chantilly Auto Body, Centreville Collision Center, Fairfax Collision Center, Metro Collision Center, Rick’s Auto Body or Quantico Collision Center), collectively CAB. I agree that CAB is not responsible for loss or damage to the vehicle or articles left in the vehicle in case of fire, theft or any other cause beyond the limits of garage owner’s liability. I also hereby grant permission to CAB employees or its agents to operate this vehicle for the purpose of testing, transporting for related work, or inspection.

    An expressed mechanics lien is hereby acknowledged on the above vehicle to secure the amount of repairs thereto. I further agree that if the amount due is referred to an attorney for collection, whether suit is instituted or not, to pay the said attorney twenty percent (20%) of the amount due as an attorney’s fee, plus any court costs.

    I acknowledge that the total estimate of repairs includes all parts, labor, handling, and diagnosis and agree that if closer analysis finds that additional repairs are necessary, I agree to approve additional supplemental repairs that will be paid for by the insurance company. I will be contacted for authorization if the amount I must pay will be increased. Acceptable methods of payment include insurance check, cash, cashier’s check, MasterCard, Visa, AMEX and personal checks (up to $500). Please do not cash or deposit the insurance check as it contains information necessary to process your claim. If your insurance check has been made payable to your lien holder and yourself you must contact your lien holder for check endorsement.

    There are many variables during the repair process not limited to parts availability, insurance claim delays and other factors which will affect both the cost of repairs on the vehicle, and the amount of time the vehicle will be needed for repair. The estimate amount and estimated down time are exactly that – they are estimates based on what can be seen at the initial inspection. CAB cannot be responsible for delays in repair that are beyond its control including items listed above and rental car payment caps imposed under my insurance policy.

    Power of Attorney:
    For consideration of repairs made to this vehicle, I hereby grant power of attorney to sign or endorse any checks and/or drafts made payable to me and any release thereto as settlement for my claim for damage to this vehicle.