Authorization Form

CUSTOMER INFORMATION

FIRST NAME

LAST NAME

PHONE

VEHICLE INFORMATION

MAKE

MODEL

YEAR

VIN

INSURANCE CLAIM NUMBER

INSURANCE CARRIER

HOW DID YOU HEAR ABOUT US? HOW DID YOU HEAR ABOUT US?

AUTHORIZATION FOR REPAIR SERVICES

REPAIR SERVICES

I hereby authorize Coon Rapids Collision to repair the above-described vehicle. This includes all necessary parts, labor, and materials required to restore the vehicle to its pre-accident condition or as otherwise agreed upon. I understand that Coon Rapids Collision will not be held responsible for any loss of personal articles left in the vehicle due to causes beyond their control. I am aware that payment in full will be due upon release of the vehicle.

AUTHORIZATION TO DISMANTLE

I authorize Coon Rapids Collision to dismantle the vehicle as necessary to perform a thorough inspection of hidden damage and to complete an estimate of the required repairs.

POWER OF ATTORNEY

I grant Coon Rapids Collision the power of attorney for insurance claims - limited for this repair only - to sign insurance checks, authorize payment from insurance companies, and negotiate on my behalf for matters related to the repair of my vehicle.

DIRECTION OF PAY

I direct my insurance company to pay Coon Rapids Collision directly for the repair services provided. Any additional charges not covered by the insurance company will be my responsibility.

PERSONAL ARTICLES REMOVED

I acknowledge that all personal articles have been removed from the vehicle before it was delivered to Coon Rapids Collision for repair. Coon Rapids Collision will not be held liable for any personal items left in the vehicle.

FUEL NEEDED TO COMPLETE SERVICES

I authorize Coon Rapids Collision to add fuel to my vehicle if necessary to complete the Advanced Driver Assistance System Calibration (ADAS), inspection, and any other required services. The cost of the fuel will be added to the final repair bill.

VEHICLE OPERATION FOR TESTING/INSPECTION

I grant permission to Coon Rapids Collision employees to operate the above-described vehicle for the purpose of testing, inspection, transferring to the mechanic shop, and ensuring the quality of repairs.

ACKNOWLEDGEMENT

By signing below, I acknowledge and agree to the terms and conditions outlined in this Service Authorization Form. I understand and accept that any delays in repair completion due to unavailability of parts or shipping delays are beyond the control of Coon Rapids Collision

SIGNATURE

Clear

DATE

We value your privacy and ensure that all your personal and vehicle information is protected. Your details will only be used to provide the services you have authorized and will not be shared with third parties without your consent.

Contact Us
If you have any questions about the authorization process or need further assistance, please contact us at:

Phone: (763) 757-0025
Email: Mell@crcglass.com or Cole@crcglass.com
Address: 11630 Jay St NW Coon Rapids, MN 55448

We look forward to serving you and ensuring your vehicle receives the best care possible at Coon Rapids Collision. Thank you for choosing us for your automotive needs.

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We look forward to getting you back on the road!
Give us a call or schedule an appointment today!

We look forward to getting you back on the road! Give us a call or schedule an appointment today!

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Authorization Form

CUSTOMER INFORMATION

VEHICLE INFORMATION

AUTHORIZATION FOR REPAIR SERVICES

ACKNOWLEDGEMENT

We look forward to getting you back on the road!
Give us a call or schedule an appointment today!

We look forward to getting you back on the road! Give us a call or schedule an appointment today!

Coon Rapids Collision

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