Online Authorization Form - Michael Jordan Collision Center

NAME*
First Last
EMAIL*
PHONE*
LICENSE PLATE #*
YEAR / MAKE / MODEL*
AUTHORIZATION TO REPAIR.*
I hereby authorize Michael Jordan Collision Center to complete the necessary repairs to my vehicle. An Estimator will provide me with an oral/written evaluation. I understand that payment in full will be due upon release of the vehicle, including any supplemental charges. I hereby grant you and/or your employees permission to operate my vehicle on streets, highways, or elsewhere for the purpose of testing, inspecting 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 Michael Jordan Collision Center responsible for loss or damage to vehicle or articles left in vehicle in case of fire, theft, accident, or any other cause beyond your control.
AUTHORIZATION TO DISASSEMBLE.*
I authorize Michael Jordan Collision Center to disassemble my vehicle for the purpose of diagnosing repairs and preparing a full estimate of the cost of repair. I understand that if I choose not to complete repairs, I may be charged for disassembly, reassembly and/or partially completed work, based on Michael Jordan Collision Center’s normal hourly labor rate.
POWER OF ATTORNEY.*
For insurance claims, I hereby appoint Michael Jordan Collision Center and its authorized employees to be my attorney-in-fact with the limited authority to sign my name on any check or draft covering repairs to my vehicle and to take such action as may be necessary to negotiate any such check or draft.
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 Michael Jordan Collision Center to access this data as part of the 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.
DIRECTION TO PAY.*
If an insurance carrier is paying for all or part of my repair order, I authorize payment to Michael Jordan Collision Center, or its affiliated companies. If a deductible is required, I will be responsible for payment. Furthermore, I authorize any and all supplement repair order amounts to be paid to Michael Jordan Collision Center.
COMPLETION OF REPAIR.*
The length of time to complete your vehicle’s repair may exceed customary time due to (i) parts availability (ii) material shortages and/or (iii) labor shortages. Due to these issues, the length of time to complete the repair may exceed the insurance company approved time for rental charges. Michael Jordan Collision Center is not responsible for rental charges beyond the insurance company approved rental period for issues outside of Michael Jordan Collision Center’s control. Michael Jordan Collision Center is not responsible for these costs and is not responsible if insurance coverage is not sufficient to pay these costs.
ADDITIONAL FUEL REQUIRED.*
Please note that if your vehicle is equipped with one or more Advanced Driver Assist Systems (ADAS) – for example blind spot monitor, lane keep assist, distance cruise control, etc – part of the repair process may include calibration of those systems. To calibrate ADAS to original equipment manufacturer specifications, certain years, makes, and models require proper weight distribution including a full fuel tank. If your vehicle and repair requires additional fuel to be added, you will be responsible for the additional cost.
REMOVAL OF PERSONAL ARTICLES.*
I acknowledge that I have removed or will remove all personal and valuable articles from the vehicle. I understand that Michael Jordan Collision Center will not be responsible for any belongings left in the vehicle.
PAYMENT OPTIONS.*
I hereby acknowledge the forms of payment Michael Jordan Collision Center accepts:
– Insurance Check
– Personal Check with a Valid Photo ID
– Business Check
– Visa, Mastercard, Discover, American Express (3% surcharge applies)
– Debit Card
– Cashier’s Check or Traveler’s Check
ELECTRONIC SIGNATURE*
Date*
Month
Day
Year
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