G.W. & SON AUTO BODY, INC. 13417 N. SANTA FE OKLAHOMA CITY, OK 73114 (405) 751-1337 FAX (405) 463-6391
I hereby authorize the needed repair work to be performed along with necessary materials. You and your employees may operate my vehicle for purposes of testing, inspection or delivery at my own risk. An express mechanic’s lien is acknowledged on vehicle to secure the amount of repairs thereto. You 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 your control. I also accept these terms of payment. If an insurance claim, I (the undersigned) do hereby appoint GW&SON, my true and lawful attorney to sign my name on any insurance drafts covering any authorized repairs to my automobile and take such action as may be necessary to negotiate said drafts. If the remittance exceeds $500.00
I understand the ONLY ACCEPTED forms of remittance are Cashier’s Check, Insurance generated Check, Visa, MasterCard, Discover and Cash.
INSURANCE CHECK & DEDUCTIBLE MUST BE RECEIVED BEFORE VEHICLE CAN BE RELEASED
I understand that repairs must be PAID IN FULL prior to delivery of vehicle.
NO PERSONAL CHECK ACCEPTED EXCEEDING $500.00
BY CLICKING SUBMIT I AM DIGITALLY SIGNING THIS FORM AND GIVING AUTHORIZATION AND POWER OF ATTORNEY TO GW & SON AS STATED FORTH IN THIS DOCUMENT.