REPAIR AUTHORIZATION

HOMETOWN COLLISION SPECIALISTS

1251 W. WHITTAKER ST. SALEM, IL 62881 618-548-1314

AUTHORIZATION TO REPAIR

I authorize Hometown Collision Specialists to repair my vehicle, unless it is an economic total loss. They and their employees may operate my vehicle for the purpose of diagnostics, inspection, and delivery.

All deductibles, customer paid repairs, betterment, and insurance repairs must be paid in full by the following means: *Cash, Money Order, Cashiers Check, Personal Check, Visa, MasterCard, Discover, or American Express. Any supplements that are left open on your account will be billed to your insurance company.

CANCELLATIONS

Should I cancel or fail to appear for my scheduled repair appointment, I understand I will be charged a cancellation and restocking fee in the amount equal to the sum of parts and shipping for items ordered by Hometown Collision Specialists, for the purpose of completing the forementioned authorized repair of my vehicle.

DIRECTION TO PAY

I authorize

to issue payment to Hometown Collision Specialists  and mail said payment directly to the repair facility.

POWER OF ATTORNEY

KNOWN ALL MEN BY THE PRESENTS: That the undersigned does hereby appoint Hometown Collision Specialists, my (or our) true and lawful attorney to sign name, place and stead of the undersigned on any Insurance Checks or Drafts issued on this claim covering any repairs to my (or our) automobile authorized by myself (or ourselves) in whatever manner is necessary to place check or draft in a cashable position. I (or we) hereby ratify and confirm whatever action said Attorney shall or may take by virtue hereof the premises.