Online Authorization Form in Wilmington, NC

Authorization Form

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Online Authorization Form

Your Name

First Last

Email Address

Phone

Repair Order Number (will be provided by shop)

Year, Make, Model & Color:

Authorization to Repair(Required)

I hereby authorize Port City Collision 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 Port City Collision 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 Port City Collision 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 Port City Collision’s normal hourly labor rate.

Power of Attorney

For insurance claims, I hereby appoint Port City Collision 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.

Direction to Pay

If an insurance carrier is paying for all or part of my repair order, I authorize payment to Port City Collision, 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 Port City Collision.

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 Port City Collision 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.

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. Port City Collision is not responsible for rental charges beyond the insurance company approved rental period for issues outside of Port City Collision’s control. Port City Collision 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 Port City Collision will not be responsible for any belongings left in the vehicle.

Payment Options(Required)

I hereby acknowledge the forms of payment Port City Collision accepts:

Insurance Checks
Personal Checks ($500 or less)
Business Checks ($500 or less)
Visa, Mastercard, Discover, American Express (3% surcharge applies to all credit card payments)
Debit Card (No surcharge on debit transactions)
Cashier’s Check or Traveler’s Check

Electronic Signature

By Signing Below, I acknowledge that I have read and understand the terms above.

Date

CAPTCHA

Authorization Form

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Online Authorization Form

WHY CHOOSE PORT CITY COLLISION

STATE-OF-THE-ART EQUIPMENT

CONFIDENT CUSTOMER SERVICE

LOCALLY-OWNED & OPERATED

LIFETIME WARRANTY

CUSTOMER SATISFACTION

ABOVE AND BEYOND