Liberty Collision Center Repair Authorization & Power of Attorney Vehicle Owner(Required) First Last Vehicle Year, Make, Model(Required)VIN#(Required)Insurance Company(Required)Claim #(Required)Repair Authorization I authorize Liberty Collision LLC to perform all repairs necessary to return my vehicle to pre-damaged condition using original equipment parts, and to dismantle my vehicle for the purpose of preparing an accurate estimate. I also authorize the operation and the transportation of my vehicle when necessary. I hereby grant Liberty Collision Center employees permission to operate the vehicle on streets, highways, or elsewhere for the purposes of testing and/or inspection. An express mechanics lien is hereby acknowledged on the vehicle to secure the amount of repairs thereto. Liberty Collision Center will not be held responsible for loss or damage to the vehicle or articles left in the vehicle in case of fire, theft, accident, or any other cause beyond your control. Old parts removed from the vehicle will be junked unless otherwise instructed. Power of Attorney & Direction of Pay Agreement I also grant Liberty Collision LLC and/or its representatives irrevocable power of attorney to collect and retain any and all differences required to repair my vehicle or the vehicle in which I have an ownership interest (referenced above), including, but not limited to, the amounts due for labor rate differences, parts price differences, repair procedures, and reduction in the value to the accident which necessitated the repair, as well as any applicable deductible. Furthermore, for and in consideration of services and materials rendered or to be rendered by the above named shop, I hereby irrevocably assign to above named repair shop and/or its representatives all of my rights, title, and interest to collect and retain any and all damages by law against my insured or uninsured motor vehicle, including, but not limited to bad faith penalties, if any, and attorney’s fees, interests and costs of collection. I understand and agree with whatever action Liberty Collision LLC shall take pursuant to and upon reliance of this Irrevocable Special Power of Attorney and Irrevocable Assignment of Rights Agreement. Liberty Collision LLC is hereby fully authorized and empowered as my attorney-in-fact to negotiate, endorse and deposit any checks or drafts in my name into their account that are received for parts, labor, materials, charges, or services pursuant to this agreement. I hereby authorize Liberty Collision Center to make the specified repairs. I understand that payment in full will be due upon release of the vehicle, including additional supplemental damage charges. I authorize any/all supplements payable directly to Liberty Collision Center. I have read and agree to Liberty Collision Center’s Repair Authorization, Power of Attorney & Direction of Pay Agreement: Signature(Required)Date(Required) MM slash DD slash YYYY Vehicle Release Policy All repairs must be paid in full prior to the vehicle release unless prior arrangements have been made. Liberty Collision Center will not be held responsible for loss or damage to the vehicle or articles left in the vehicle in case of fire, theft, accident, or any other cause beyond your control. We accept the following forms of payment: Insurance Draft/Check Certified Check or Money Order Cash All major credit cards ( subject to a 4% CC processing fee) All deductibles are payable to Liberty Collision Center. Two and Three party checks must be endorsed by all parties including lienholders prior to vehicle release. I have read and agree to Liberty Collision Center’s Vehicle release policy: Signature(Required)Date(Required) MM slash DD slash YYYY Name(Required) First Last Phone(Required)Email(Required) I understand that the estimated delivery date is not guaranteed and is subject to changeInitial(Required)Date(Required) MM slash DD slash YYYY Vehicles not picked up within 5 days of completion will be charged a $100 per day storage feeInitial(Required)Date(Required) MM slash DD slash YYYY CAPTCHA
