CARBON COLLISION CENTER

Repair Authorization

First, Last Name

Phone:

Email:

Vehicle Year, Make, Model, Color

Insurance (If not going through insurance type "customer pay")

Claim # (if applicable)

I hereby authorize Carbon Collision Center to perform the necessary repairs to my vehicle, including any required parts, labor, and diagnostic work. I understand that any repair estimate is based on preliminary finding and does not cover additional parts, sublets or labor that might be required to complete the repair(s). If parts need to be returned due to cancellation of repairs, I will be responsible for any restocking fees, disassembly charges, and administrative fees, if applicable. Carbon Collision Center will dispose of old parts removed from the vehicle unless otherwise instructed. I also grant Carbon Collision Center employees permission to operate my vehicle on streets, highways, or elsewhere for the purpose of testing and/or inspection. Liability Disclaimer Carbon Collision Center will NOT be responsible for any loss or damage to the vehicle or articles left in the vehicle due to fire, theft, accident, or any cause beyond the control of the company. Customers are advised to remove personal belongings. Limitation of Liability, Carbon Collision Center in no event shall be liable for special, consequential or indirect damages of any nature, and Carbon Collision Center’s maximum liability shall be no greater than the amount actually paid to, and received by, Carbon Collision Center for the services performed on the vehicle. Vehicle Data Privacy During the repair process, Carbon Collision Center may perform a diagnostic scan, which could collect historical vehicle data, including but not limited to the date, time, and mileage at which diagnostic trouble codes (DTCs) were created. This information helps determine whether an issue is accident-related or pre existing. By authorizing repairs, you acknowledge that this information may be shared with your insurance company or other relevant third parties. Carbon Collision Center does not collect or store personally identifiable information during any scanning activity. Power of Attorney I hereby appoint Carbon Collision Center as my Power of Attorney to accept and endorse checks, drafts, or bills of exchange on my behalf for deposit into Carbon Collision Center’s account as payment for the repair of my vehicle. Carbon Collision Center is NOT responsible for rental vehicle charges (including insurance costs) incurred during the repair process. ● Estimated completion dates are not guaranteed and are subject to change based on parts’ availability and repair conditions. TYPE YOUR NAME BELOW TO SIGN (Registered Owner)

New Field:

This deductible is due upon completion of the repair work and at the time of pick-up. Payment can be made via CASH (Exact Change), Debit/Credit Card (Visa, Mastercard, Discover, American Express). A 3.5% processing fee applies to all debit and credit card transactions. WE DO NOT ACCEPT PERSONAL OR THIRD-PARTY CHECKS Insurance checks must be endorsed and received prior to vehicle release. All repairs must be paid in full PRIOR to vehicle release PLEASE SIGN YOUR NAME BELOW FOR DEDUCTIBLE AMOUNT. (Acknowledging Deductible Amount):

Registered Owner

Date

Time

Repair Authorization

CARBON COLLISION CENTER

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