Auto Body Shop Direction To Pay Form

I hereby authorize Exclusive Collision & Repair INC to start the repairs on my vehicle stated above. I grant permission for work to be done along with the necessary material, and hereby grant you/your employees permission to operate the vehicle herein described on streets, highways, or elsewhere for the purpose of testing/inspecting.

Exclusive Collision & Repair INC is not responsible for the availability of parts or delays in part shipments beyond their control, nor for the loss, damage, or articles left in the vehicle in case of fire, theft, or any cause beyond our control. Exclusive Collision & Repair INC is not responsible for any boots or towing due to outstanding tickets. Exclusive Collision & Repair INC is not responsible for REPO of your car due to non payment.

I do hereby appoint the aforementioned business to accept on my behalf any and all checks, drafts, or bills of exchange for deposit to the mentioned business account for credit on the repairs to my vehicle which has been released and accepted.

I authorize my Insurance Company which is stated above to pay Exclusive Collision & Repair INC directly on the claim number that is stated above. In the event that the insurance or the adjustment company inadvertently mails the settlement/supplement check to me in error, I hereby agree to notify the said shop immediately, and I agree to deliver the check amount in full to the repair facility within 24 hours of my receipt.

If payment is not made in full the car will not be released. All checks and payments are to be sent to Exclusive Collision & Repair INC at 28 Marginal St W, Brooklyn, NY 11207.