All City Auto Body and Tow

305 Rockaway Avenue, Valley Stream NY 11580

Designated Representative:

I authorize the above repair shop to point out any and all damages found on my vehicle on behalf of myself. Let it be known that the claim is being made by myself the Insured or clamant and not the repair shop. Any statement of fact is the sole responsibly of the insured or the claimant I authorize the shop to dismantle my vehicle for the purpose of estimating/inspection. I also agree that the repair shops not responsible for loss damages to vehicle or articles left in vehicle in cases of fire theft or any cause beyond control or for any delays caused by unavailability in parts, shipments by the supplier or transfers.

I hereby grant you and/or your employees' permission to operate my vehicle herein described and streels, highways, or elsewhere I have authorized the above company to sign my vehicle out of any repair shop DARP/ROTOW program on (Fill form below)  so that my vehicle can be brought to the above company for an estimate or repairs and be repaired. I further authorize a storage fee of $65.00 (sixty-five) per day when I am informed by the shop. I authorize the repair shop or its agents to proceed with any complaints or actions arising from my loss to any ally or state agency on my behalf.

Repair Order:

I authorize the above repair shop to repair my vehicle as per the body shop estimate. The insurance company estimate is utilized to determine a dollar amount for the insured/claimant reimbursement. Shop guarantee on all repairs is for 90 days or 3000 miles from date or estimate to be performed. I authorize the use of parts and restraints where applicable. All repairs are to be paid in cash unless otherwise noted on paper by the shop

Direction For Payment:

I am the insured/claimant or person representing them, authorize the above repair shop or its representatives to collect, deposit and endorse me for any and all payments made payable to the Insured/claimant as a result of this loss

Any mention of owner/claimant insured in the above statement to mean the owner of the vehicle or anyone acting as the owner's representative who ls authorized to operate the vehicle and/or handle any and all matters/pertaining to the above-described vehicle and may also authorize the above statements