Authorization

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By email?YesNo

Work Authorization

I hebery authorize the repair work that has been explained to me to be done along eith the necesary materials. I agree that Kolex Collision Center is not responsible for loss or damage to my vehicle or articles left in case of fire, theft, or any other cause beyond Kolex Collision Center's control; or for any delays caused by unavailability of parts or delay in parts shipments by the supplier or transporter. I hereby grant you and/or your employees' permission to operate the vehicle herein described on street, highway, or elsewhere for the purpose of testing and/or inspection. An express mechanic's lien is hereby acknowledged on the vehicle to secure the amouunt of repairs thereto.

Direction Pay

I authorize the insure company listed above to pay Kolex Collision Center directly for repairs to my vehicle and grant Kolex Collision Center power of attorney to receive and deposit any payments related to this claim.

Accepted By:

Date:

BY CLICKING SUBMIT I AM DIGITALLY SIGNING THIS FORM AND GIVING AUTHORIZATION AND POWER OF ATTORNEY TO KOLEX COLLISION CENTER AS STATED FORTH IN THIS DOCUMENT.