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First Name

Last Name

Phone

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I hereby authorize the repair of the vehicle identified above by VINS Auto Care & Collision (“VAC”) acknowledge that VAC is not responsible for loss or damage of the vehicle or articles left in the vehicle in case of fire, theft or any other cause beyond VAC’s control; or for delays caused by unavailability of parts or shipping delays. I grant permission to VAC employees to operate this vehicle for the purpose of testing, transporting for related work, or inspection. An expressed mechanic's lien is hereby acknowledged on above vehicle to secure the amount of repairs. I further agree to pay attorney fees and court costs in the event that legal action is necessary to enforce this contract. TERMS: I acknowledge the estimate of repairs includes parts, labor, handling and diagnosis. I agree that closer analysis may show that additional repairs are necessary that are not apparent on the initial examination. Should such additional repairs be necessary and not approved by the insurance company, I agree to personally pay for increased repairs. I authorize the insurance company handling this claim to pay VAC directly any balance remaining due on the repairs made to my vehicle. l understand that my vehicle may be released to me based on written communication for payment guarantee by the insurance company to VAC. I further acknowledge any balance is ultimately my responsibility and I agree to pay said balance in full and immediately upon demand should the insurance company fail to pay the balance due within thirty (30) days. *

I consent to the above terms.