Authorization Form General Information:Location*LincolnGrand IslandKearneyLexingtonCozadEustisName* First Last Email* Authorized and Accepted:Statement:* You are hereby authorized to make the above specified repairs. I understand that payment in full will be due upon release of the vehicle, including additional supplemental damage charges. I agree that if I cancel the repairs and there are parts to be returned I will pay a restocking fee on those parts. I hereby grant you and/or your employees permission to operate the vehicle here in described on the street, highway or elsewhere for the purpose of testing and/or inspection. An express mechanic’s lien is hereby acknowledged on the above vehicle to secure the amount of repairs thereto. Eustis Body Shop, Inc. will not be held responsible for loss or damage to vehicle or articles left in vehicle in case of fire, theft, accident or any other cause beyond our control. Parts removed from the above vehicle will be discarded unless otherwise instructed.*Repair Order authorized by* Reset signature Signature locked. Reset to sign again Date* MM slash DD slash YYYY Pre and Post-Repair Diagnostic Scan Authorization:Diagnostic Scan Authorization* Yes - I accept having a pre and post-repair diagnostic scan performed on my vehicle, even if my insurance coverage does not pay for these procedures. In some instances, insurance coverage may not be determined until after the diagnostic scans are performed. No - I decline having a pre and post-repair diagnostic scan on my vehicle, though they were recommended by Eustis Body Shop, Inc. and the need for them was explained to me. I understand Eustis Body Shop, Inc. will not be held liable for any hidden damage that could not be detected during the repair process as a result of not having performed a pre-repair scan. I also understand certain systems may not function correctly, or at all, following the repair, and it would be impossible to detect issues with those systems without a post-repair diagnostic scan. I release Eustis Body Shop, Inc. from all liability for any pre-accident issues, hidden damage or post repair malfunctions that would have been discovered, had I consented to having pre and post-repair diagnostic scans performed. Direction to Pay:Statement:* I have received a copy of the initial and the final automated repair estimate.*Authorized by* Reset signature Signature locked. Reset to sign again Date* MM slash DD slash YYYY
