Legally Binding Repair Authorization and Consent

This document serves as a formal and legally binding agreement between and the undersigned customer. By affixing your digital signature, you acknowledge your consent to the outlined repair services, terms, and conditions, and agree to comply with all relevant legal requirements. Please read carefully before proceeding.

Your Details:

Vehicle Details:

Insurance Information: (Required if using Insurance)

PLEASE READ CAREFULLY, CHECK ONE OF THE STATEMENTS BELOW, AND SIGN:

I UNDERSTAND THAT, UNDER STATE LAW, I AM ENTITLED TO A WRITTEN ESTIMATE IF MY FINAL BILL WILL EXCEED $100.

I DO NOT REQUEST A WRITTEN ESTIMATE AS LONG AS THE REPAIR COSTS DO NOT EXCEED $
THE SHOP MAY NOT EXCEED THIS AMOUNT WITHOUT MY WRITTEN OR ORAL APPROVAL.

COMPANY INVOICE

MV:

MVR:

Address:

Phone Number:

  • *U/Used
  • R/Repaired
  • A/Aftermarket
  • S/Straightened
  • M/Manufactured Part

LABOR HOURS

  • QTY
  • *
  • Part No.
  • Description
    CUSTOMER COMPLAINT/PROBLEM CLAIM #
  • Body
  • Paint
  • Frame
  • Mech

All parts and labor are warrantied for months/ miles unless otherwise stated.

Vehicle Information

  • Save Parts:

    No
  • Core may apply:

    Yes

Charges based on:

  • Hourly Rate
  • Flat Rate
  • Both Apply

Estimate Diagnosis:

  • Fee: $ or
  • Hourly at $ /hr.

Payment Method:

  • Cash
  • Check
  • Visa
  • MC
  • Amex

Estimated Cost: $

**This charge represents costs and profits to the motor vehicle repair facility for miscellaneous shop supplies or waste disposal.

***s. 403.718, F.S. mandates a $1.50 fee for each new or manufactured battery sold in the State of Florida.

Estimate good for 30 days. The facility is not responsible for damage caused by theft, fire, or acts of nature. I authorize the above repairs to my vehicle including the necessary materials and sublet work. You and your employees may operate my vehicle for the purpose of testing, inspection, and delivery at my risk. If I cancel repairs to my vehicle for any reason, I understand that a tear-down and reassemble fees of $ will apply. I understand that a charge of $ per day will be charged if I fail to pick up my vehicle within (3) working days of notification of completion.

  • Body Hours/@ Paint Hours/@ Mech Hours/@ Paint Supplies Body Supplies Tow Storage Epa/Waste Miscellaneous
  • $
  • Parts: Labor: **Shop Sup: Sublet: ***Fees: Subtotal: Tax: Total:
  • $ $ $ $ $ $ $ $

Repair Agreement

I hereby authorize the required repair work to be completed for my vehicle along with the necessary materials. I hereby grant PSG Paint & Body Shop and its employees permission to operate the vehicle herein described on the street, highway, or elsewhere for the purpose of testing and section. An express mechanics lien is hereby acknowledged on the above vehicle, should the need occur, secure the amount of the remaining balance due. No vehicle will be released until payment is made in full. Please be certain all payees (including all lien holders) have endorsed the insurance check prior to the completion of repairs.

I understand that PSG Paint & Body Shop's final invoice for repairs of my vehicle may not match that of the insurance company's estimate as to parts, labor, or procedures used to repair my vehicle. I understand that parts prices are based upon recent Estimating Software; however, prices may vary due to currency fluctuations or varying supplier costs. I understand that repair techniques employed are based upon PSG Paint & Body Shop's judgment as to the best means of effecting a high-quality repair and that PSG Paint & Body Shop's labor charges are based upon hourly time allowances as given in the Collision repair industry estimating software, and their experience, and maybe more or less than the amount of actual time.

I understand that all PSG Paint & Body Shop's estimates and final invoices are based upon flat rate hours, as is customary in the Collision Repair industry, not actual time spent on repair. I understand that a flat rate hour is a unit of time given for a certain repair operation and that actual time spent on a repair operation can vary greatly from the flat rate time given to a labor procedure depending on technician experience and equipment provided and/or training.

PSG Paint & Body Shop is not responsible for loss or damage to vehicles and/or articles left in vehicles in case of fire, theft, or any cause beyond our control. Please remove any personal articles from your vehicle as it may be necessary to have outside companies do sublet work on your vehicle. Storage charges will accrue 3 days after notification of the completion of repairs. Failure to make a payment within 20 days of notification of the completion of repair will result in the commencement of the auction process to satisfy the implied mechanic's lien.

In the event that an insurance company fails to provide an estimate or there is an inability to come to an agreed price for the cost of either the initial estimate or supplement within 10 business days of the vehicle arriving at PSG Paint & Body Shop, there will be an inside storage charge of $150 per day and an outside storage charge of $100 per day beginning with the day the vehicle arrived.

Vehicles towed or driven in, then deemed a total loss, or moved to another facility for any reason by the customer or Insurance Company may be subject to administrative, lost, debris cleanup charges or estimate fees. Any labor, towing, or lift inspection fees must be paid before the vehicle leaves PSG Paint & Body Shop Prior written notice must be given if the return of used or damaged parts is desired by the customer.

Direction to pay

In the event that an insurance carrier is paying for all or part of my repair cost, I authorize payment to PSG Paint & Body Shop, and its affiliated companies. I will be responsible for paying any deductible attached to my claim. I authorize PSG Paint & Body Shop's payment to any and all supplement repair order amounts.

No Agreement Terms Available

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