972-438-6766

Mon to Fri 8am-6pm
Sat by Appointment

Online Authorization

Name

Address

City

State

Zip

Home Phone

Work Phone

Cell Phone

Email Address

Date

In order to ensure you are completely satisfied with your repair experience, we would like to know the best way to keep you informed on the status of your vehicle throughout your repair.
My preferred method of communication for BW Collision Repair updates on my vehicle’s repair is:

Text Email Cell Phone Home Phone Work Phone

If you prefer to be contacted by phone, please designate the frequency:

Once Per Week Twice Per Week

We will always contact you by phone if there are any changes to your vehicle status that directly affect your delivery time.

Do you have any concerns about your vehicle repair or claim?

Will you be working with an insurance company on your repairs?

YES NO

If Yes, Insurance Company Name:

Date of Accident:

Claim Number:

Deductable:

YES NO

If Yes, Amount of Deductable:

Who can we thank for referring you to BW Collision Repair?

Insurance Agent Insurance Company Dealership Friend/Family Other

Referrer's Name

Please note that by selecting YES below, you are authorizing BW Collision to begin repairs on your vehicle.

YES NO

• We work with every major insurance company in America. •
• We are consistently ranked among the highest customer satisfaction scores in the industry. •
• Our repair work is backed by a written, lifetime warranty honored at BW Collision Repair. •

Please contact Ricky Harper at BW Collision Repair for any questions or comments.
972-438-6766 | Ricky.Harper@BWCollision.com

BW COLLISION REPAIR PAYMENT OPTION

BW Collision Repair accepts the following forms of payment:
Insurance Check, Personal or Business Checks*, Visa, MasterCard, Discover, American Express, Debit Card, Cashier’s Check or Traveler’s Check.
*Subject to TeleCheck acceptance.

AUTHORIZATION TO REPAIR

I hereby authorize BW Collision Repair to complete the necessary repairs to my vehicle. A service Advisor will provide me with an oral/written evaluation. I understand that payment in full will be due upon release of the vehicle, including any supplement charges. I hereby grant you and/or your employees permission to operate my vehicle on streets, highways, or elsewhere for the purposes of testing, inspection or sublet repairs, and delivery or pick up. An Express Mechanic’s Lien is hereby acknowledged on above vehicle to secure the amount of repairs thereto. I will not hold BW Collision Repair responsible for loss or damage to vehicle or articles left in vehicle in case of fire, accident or any other cause beyond your control. I authorize any and all supplements to be paid directly to BW Collision Repair.

AUTHORIZATION TO ACCESS VEHICLE DATA

I understand that modern vehicles are complex and that electronic data recorded in vehicle systems may help to diagnose necessary repairs and to confirm that applicable systems are functional after repairs are performed. I authorize BW Collision Repair to access this data as part of the diagnostic and repair process and to include this data in compilations that may be used to study the causes of accidents or to achieve improvements in repair processes.

POWER OF ATTORNEY

For insurance claims, I hereby constitute and appoint BW Collision Repair and it's authorized employees to be my true and lawful attorney-in-fact with authority to sign my name on any check or draft covering repairs to my automobile and to take such action as may be necessary to negotiate any such check or draft.

NOTICE PURSUANT TO SECTION 70.001, TEXAS PROPERTY CODE

I am the person or agent acting on behalf of the person, who is obligated to pay for the repairs of the motor vehicle herein described. I understand that this vehicle is subject to repossession in accordance with Section 9.609, Texas Business & Commerce Code, if a written order of payment for repairs of the vehicle is stopped, dishonored because of insufficient funds, no funds, or because the drawer or maker of the order has no account or the account on which is drawn has been closed.

REMOVAL OF PERSONAL ITEMS

I acknowledge that I have removed all unattached personal and valuable articles from the vehicle. I understand that BW Collision Repair will not be responsible for any belongings left in the vehicle.

ACKNOWLEDGED/ACCEPTED BY:

*Typing first and last name serves as electronic signature

Date