June 30, 2024 AUTHORIZATION FORM Falls Church Authorization Form Name * First Last * Last Phone * Email * Make * Model * Year (optional) Claim number (optional) Payment Type * Insurance ClaimSelf-pay (Cash on Delivery) If Insurance Claim, Name of Insurance Company TERMS AND CONDITIONS TERMS AND CONDITIONS I HEREBY GRANT FALLS CHURCH AUTO BODY TO REPAIR MY VEHICLE TO PRE- ACCIDENT CONDITION TO THE BEST OF THEIR ABILITY WHILE TRYING TO ADHERE TO THE HIGHEST STANDARDS AND QUALITY AVAILABLE. I GRANT PERMISSION TO THE EMPLOYEES TO MOVE AND /OR OPERATE SAID VEHICLE FOR PURPOSES OF TESTING OR REPAIRING. FALLS CHURCH AUTO BODY STANDS BEHIND A LIFETIME WARRANTY ON ALL OF OUR BODY AND PAINT REPAIRS. PLEASE REMEMBER THAT INSURANCE IS CONSIDERED A METHOD OF REIMBURSEMENT FOR COSTS OF REPAIRS TO THE VEHICLE. PAYMENT IS YOUR RESPONSIBILITY!!! NO VEHICLE WILL BE RELEASED UNTIL PAYMENT IS MADE IN FULL. DEDUCTIBLE, INSURANCE CHECK, OR PROOF MUST BE RECEIVED AND/ OR AGREED BEFORE VEHICLE WILL BE RELEASED. FALLS CHURCH AUTO BODY IS NOT RESPONSIBLE FOR ANY LOSS OF INCOME CAUSED BY YOUR VEHICLE BEING IN THE SHOP DUE TO AN ACCIDENT. FALLS CHURCH AUTO BODY IS NOT RESPONSIBLE FOR ANY RENTAL CAR LIABILITY OR COSTS INCURRED BY THE CUSTOMER. RENTAL CAR SITUATIONS ARE BETWEEN YOU AND THE INSURANCE COMPANY. THE MILAGE ON YOUR VEHICLE AT TIME OF DROP MIGHT BE DIFFERENT THAN THE ONE STATED ON YOUR ESTIMATE. PLEASE BE ASSURED THAT WE ARE DEDICATED TO QUALITY REPAIRS, WE REPRESENT YOU IN TRYING TO FULFILL THAT GOAL. WE ARE AN AUTO BODY REPAIR FACILITY, NOT AN INSURANCE COMPANY OR A RENTAL CAR COMPANY. WE STAND BEHIND ANY AND ALL OF OUR REPAIRS, BUT WE CANNOT BE HELD ACCOUNTABLE OR RESPONSIBLE FOR RENTAL CAR OR PAYMENT ISSUES. PLEASE DONT FORGET TO REMOVE ALL VALUABLES FROM YOUR VEHICLE BEFORE IT COMES TO THE SHOP FOR REPAIRS. WE CANNOT BE RESPONSIBLE FOR LOST OR STOLEN PERSONAL ITEMS. WE ACCEPT INSURANCE CHECKS MADE OUT SOLELY TO FALLS CHURCH AUTO BODY, MC, VISA, AMEX, DISCOVER, CASH, CERTIFIED OR CASHIER CHECKS. SORRY, WE CANNOT ACCEPT PERSONAL, COPAY, OR THIRD PARTY CHECKS!! THANK YOU FOR THE PRIVILEGE OF REPAIRING YOUR VEHICLE! Date Signature signature keyboard Clear Submit Δ Share this: Click to share on X (Opens in new window) X Click to share on Facebook (Opens in new window) Facebook Like this:Like Loading...