Repair and Parts Authorization

I authorize the Glenbrook Collision Center to estimate and repair my vehicle, unless it is an economic total loss.  I have received a copy of the preliminary estimate written by the above mentioned collision center.  I understand that I will be notified by the collision center in advance if my vehicle requires additional repair work, unless the additional repairs are being covered by my insurance company.  I also understand that the collision center will not be held responsible for any items left in the vehicle in case of fire, theft, or any other cause beyond our control.  I understand that there may be delays involved during the repair process due to parts availability and/or shipping.  I understand that if repairs are stopped at my request, I am responsible for any restocking fees for returned parts.  I give the above mentioned collision center and its employees permission to operate my vehicle to perform diagnostics and test drives.  I further understand that at the completion of the repairs to my vehicle I will be notified by the collision center to arrange delivery.  At which time I will surrender any Insurance checks issued to me by the insurance company.  I will also pay my deductible if applicable, and if there are additional charges being covered by my insurance company, the collision center will secure a power of attorney for the supplement payment issued by the insurance company.  An express Mechanics Lien is hereby acknowledged on the vehicle listed below to secure the amount of repairs thereto. 

Glenbrook Collision Center cannot be held liable for valuables left in your vehicle.  It is recommended that all valuables be removed from your vehicle before leaving it for repairs.

 

Please complete the form below

Name *
Name
Contact Phone *
Contact Phone
I Authorize *
I authorize Glenbrook Collision Center to repair my vehicle
The authorization code must be provided by a Glenbrook Collision Center representative. If you don't have a code contact us at 260-481-2000.