Authorization Form – Prime Time Collision LLC

Repair Consent Form

Schedule Your Vehicle Repair Appointment

To get started with your vehicle repair, please complete the Repair Consent Form. This form allows us to collect the necessary information to schedule your service appointment and ensure a smooth repair process.

Name Name[text] Email [email] Phone [tel]

Address Line 1 *

Address Line 2

City *

State *

Zip *

FEES: Diagnosis fee: Starts at $135/hourly (this charge will be applied towards the vehicle repairs if you choose to repair in facility). If the vehicle is left here 8 days after repairs are completed, we will begin to charge $65/day storage fee. CUSTOMER GIVES US POWER OF ATTORNEY WHEN INSURANCE SENDS CHECKS FOR REPAIRS. PARTS: Would you like us to save your old parts?YesNo IF PARTS ARE A CORE, WE WILL NOT BE ABLE TO RETURN THEM TO YOU. I hereby authorize the repair work to be done with the necessary parts and materials and grant permission to you and/or your employees to operate the vehicle described above on streets, highways, or elsewhere at your discretion for the purpose of testing and inspection. A mechanic’s lien is hereby acknowledged on the above vehicle to secure payment for the completed repairs. I understand that the collision center and its parts suppliers are not responsible for delays or other consequences resulting from the unavailability of parts or shipping issues beyond their control. I also authorize a partial tear-down of the vehicle to allow the insurance company to assess all damages, and I understand that I will be contacted by PRIMETIME COLLISION LLC. with the total cost of repairs. WORKER LIEN: "Sec. 70.001. WORKER’S LIEN. (a) A worker in this state who by labor repairs an article, including a vehicle, motorboat, vessel, or outboard motor, may retain possession of the article until. 1. The amount due under the contract for the repairs is paid; or 2. If amount is specified by contract, the reasonable and usual compensation is paid.” NOT RESPONSIBLE FOR DAMAGE OF OBJECTS LEFT IN CAR IN CASE OF FIRE, THEFT, OR ANY OTHER CAUSE BEYOND OUR CONTROL. CONSENT TO MAKE REPAIRS: I, do hereby authorize PRIMETIME COLLISION LLC. to perform the prescribed repairs and replace any parts necessary to complete those repairs. I understand that the estimate is based on preliminary inspection and may be required to complete the needed repairs. I also authorize a partial tear-down of the vehicle so that the insurance company has access to all damages, and I understand that I will be contacted by PRIMETIME COLLISION LLC. for the cost of the repairs. Customer Signature:

Repair Consent Form

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