Authorization To Repair For Hewlett Collision Center located at 101 Page Whitney Parkway, Georgetown, TX 78626 Customer(Required) First Name Last Name R.O. NumberCustomer Email(Required) Enter Email Confirm Email Description of UnitYear(Required)Make(Required)Model(Required)Color(Required)VIN(Required)License Plate No.(Required)Mileage(Required)Existing Estimate(Required) Yes No Has Customer Received Insurance Payment?(Required) Yes No AmountDeductible Amount(Required)Authorization to Repair: You authorize Hewlett Collision Center (HCC) to disassemble, order all necessary parts and repair your vehicle in accordance with the estimate of repairs from the involved insurance company or an estimate prepared by us. You authorize us to drive your vehicle to diagnose, repair, service and inspect the vehicle.Supplements: While repairing your vehicle, if we discover additional necessary repairs, you authorize us to prepare supplements to the estimate and notify the responsible party. As a courtesy to you we will bill the involved insurance company for supplements.Cancellation: In the event you cancel the repair for any reason, including the involved insurance companies’ subsequent decision to “total” your vehicle, you will pay for all repairs completed through the date of cancellation, all related charges, and a parts restocking fee of twenty percent (20%) on all parts accepted for return.Payment: PAYMENT OF ALL CHARGES, INCLUDING SUPPLEMENTS MUST BE RECEIVED BY US BEFORE WE WILL DELIVER YOUR VEHICLE TO YOU. If the charges are covered by insurance we request you use the insurance check to make payment at the time of delivery. YOU ARE RESPONSIBLE FOR ANY CHARGES NOT COVERED BY THE INVOLVED INSURANCE COMPANY INCLUDING ANY APPLICABLE DEDUCTIBLE.Power of Attorney and Direction to Pay: By signing below you are appointing HCC as your attorney in fact and directing any involved insurance companies to make payment directly to us, as follows: I do hereby constitute and appoint Hewlett Collision Center as my true and lawful agent and attorney in fact to endorse any check or draft and sign any instrument in my name, place and stead that is issued or requested by any insurance company to cover all or part of the repair costs of my vehicle. I ratify and confirm all actions said agent and attorney in fact may take by virtue of this power. I authorize and direct each involved insurance company to make all repair and supplement checks payable to Hewlett Collision Center and to deliver same directly to HCC on my behalf.Estimated Repair Time: You understand that due to the complexities of the repair, parts availability issues, responsiveness of involved insurance companies, disputes over fault or coverage, or discovery of additional damage we can only provide an estimated repair completion date. YOU UNDERSTAND THAT SUCH ESTIMATED DATE IS NOT A GUARANTEED DATE OF COMPLETION. We are not responsible for additional rental car expenses or other expenses incurred by you due to delays in completion of the repairs.Parts: We use original equipment manufacturer parts when available unless otherwise instructed in writing by you or the involved insurance company. You are responsible for resolving any disputes with involved insurance companies over the use of aftermarket or non-OEM parts. Actual parts prices may vary from original estimates based on market price changes.Storage and Related Fees: If you move your vehicle to another repair shop, or if we are required to store your vehicle while waiting on involved insurance company approvals or total loss decisions, additional authorizations by you, liability disputes to be resolved, or other delays to the commencement of repairs beyond our reasonable control, storage fees, security fees, weatherization fees, and other related fees will accrue and be added to the cost of repairs. Payment and removal of your vehicle is required within three (3) business days following completion of repairs. Storage fees will accrue thereafter. STORAGE: ......$70/DAY + TAXGATE FEE: ......$150ADMIN FEE: ......$500BLUEPRINT FEE: ......$600HAIL SCOPE FEE: ......$562.50Remove Your Items: We are not responsible for any items left in your vehicle during the repair process. We will have no responsibility for loss or damage to your vehicle because of theft, fire, vandalism, weather or other act or event beyond our reasonable control.Consent(Required) I have read this authorization and agree to the termsYOUR SIGNATURE CONFIRMS THAT YOU HAVE READ THIS AUTHORIZATION AND AGREE TO THE TERMS. NOTICE PURSUANT TO SEC. 70.001 TEXAS PROPERTY CODE. HEWLETT COLLISION CENTER WILL HAVE A POSSESSORY WORKER’S LIEN ON THE VEHICLE. AS THE PERSON AUTHORIZING THE REPAIRS AND OBLIGATED TO PAY FOR THEM, YOU UNDERSTAND THAT YOUR VEHICLE IS SUBJECT TO REPOSSESSION IN ACCORDANCE WITH SEC. 9.609 TEXAS BUSINESS & COMMERCE CODE IF HCC RELINQUISHES POSSESSION OF THE VEHICLE IN RETURN FOR A CHECK, MONEY ORDER OR A CREDIT CARD TRANSACTION ON WHICH PAYMENT IS STOPPED, HAS BEEN DISHONORED BECAUSE OF INSUFFICIENT FUNDS, NO FUNDS OR BECAUSE THE DRAWER OR MAKER OF THE ORDER OR THE CREDIT CARD HOLDER HAS NO ACCOUNT OR THE ACCOUNT UPON WHICH IT WAS DRAWN OR THE CREDIT CARD ACCOUNT HAS BEEN CLOSED.Customer Signature(Required)CommentsThis field is for validation purposes and should be left unchanged.
