VIN #:

- I hereby authorize the repair work to be done along with the procurement of the necessary materials for the estimated price of $

- I acknowledge that the total estimate of repairs includes all parts and labor and agree that, if closer analysis finds that additional parts and repairs are necessary OR if the manufacturer of the parts passes a price increase to the supplier, this will affect the final price of the repair bill. I will be contacted for verbal authorization if the amount I must pay is increased from the agreed estimated price.

- All deductibles, customer paid repairs, betterment, and insurance repairs must be paid in full by the following means:

1) Cash or Money Order

2) Insurance Check

3) Personal Check (up to $500 with Driver License #)

4) Visa, MasterCard, American Express or Discover (up to $1000)

5) Certified or Bank Check

Any supplements that are left open will be billed to your insurance company with a signed direction to pay, Credit Card & Drivers License numbers as security.

- There will be a 20% parts restocking fee if a repair is cancelled after shop has received parts.

- I understand that it is my responsibility to remove personal belongings from the vehicle prior to repair. I agree that you are not responsible for any loss or damage to the vehicle or articles left within it, in case of fire, theft or any other cause beyond your control or for delays caused by unavailability of parts or delays in shipment by the supplier or transporter.

- I hereby grant you and/or your employees' permission to operate the vehicle for the purpose of testing and or inspection.

- An express mechanic's lien is hereby acknowledged on the vehicle to secure the amount of repairs thereto, and I agree to pay all reasonable attorneys' fees and court costs in the event legal action is necessary to enforce this contract. For consideration of repairs made to this vehicle, I hereby authorize a D & M Auto Body representative to endorse my name to any insurance checks received for payment of repairs.

- The customer has the right to inspect or receive replaced parts if the customer makes a written request prior to repairs.

- The customer or insurer has the right to inspect the repaired vehicle before paying for the repair work.

Warranty Terms and Limits: These repairs are covered by a limited lifetime warranty. Parts and materials subject to terms as extended by each manufacturer or vendor. Warranty repairs to be performed at D & M Auto Body.

Storage Notice: Customers of this facility are hereby notified that we charge storage at the rate of $35 per day on vehicles left at our facility that we do not repair or vehicles not picked up within 48 hours after repairs are completed. Storage or stall tie up time will also be charged while waiting for any insurance company inspections.

Estimated Date of Delivery Notice:

Estimated Date of Delivery . Estimated date of delivery may change due to parts delays, additional repairs, weather conditions, insurance related delays or unforeseen and uncontrollable factors.

Date :

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