STATEN ISLAND'S PREMIER COLLISION REPAIR SPECIALISTS

Vehicle Details

Designated Representative Authorization

I (Above Owner) insured by: ___________________________ hereby authorize Fast Track Auto Body and my/our designated representative to reach an agreed price with the insurance company as to the reasonable cost to repair my/our vehicle. The designated authorization is in conformance with New York State Department Regulations No. 64 and is NOT an authorization to repair.

Authorization To Repair

AS AGREED TO REPAIR FOR INSURANCE

COMPANY PRICE ONLY AND PER SHOP’S ESTIMATE

TO OWNER OR PERSON IN CHARGE OF DAMAGED VEHICLE:

Please read all printed matter before signing, all complaints as to quality of repairs must be made to the New York State Department of Motor Vehicles. No Towing Company or Insurance Company may require that repairs be made to a motor vehicle in a particular place or repair shop.

You have the right to have your motor vehicle repaired in the shop of your choice.

1. Do Not sign this “Authorization To Repair” at the scene of the accident. You can not be required to do so.SIGN ONLY AT:
• The place to which vehicle is towed to, or
• Your home or place designated by the person in charge of the disabled vehicle, or
• The hospital, if you are hospitalized but not before twenty-four (24) hours after the accident unless you are discharged from the hospital, before that period of time.
2. Before signing your name to the bottom of this form, print/write in your own handwriting in the spaces provided: I authorize the repair of the vehicle indicated above.

Authorization To Dismantle

I (Above Owner hereby authorize) Fast Track Auto Body to dismantle my vehicle prior/after Insurance Company Inspection to see any hidden and related damage. Fast Track Auto Body reserves the right to exercise this agreement at any time.

Authorization To Dismantle

I (Above Owner) hereby authorize _______________________ on my claim # _______________________ to directly pay Fast Track Auto Body, I understand that by signing this authorization, I give permission to also make two party check, and have Fast Track Auto Body, sign on my behalf.

Department of Motor Vehicles Notification

I authorize Fast Track Auto Body, to charge $100.00 per day storage and/or $200.00 per day for indoor storage for the above vehicle.