Collision Specialists, Inc. is hereby authorized to make the repairs to my vehicle. I hereby grant you and/or your employees permission to operate the car, truck or vehicle on streets, highways or elsewhere for the purpose of testing and/or inspection.
I understand that my deductible payment in the amount provided here. I must also pay for any "self pay" or betterments before vehicle can be released. I must also provide payment for any checks/direct deposits I have received from the insurance company for this repair.
An express mechanic’s lien is hereby acknowledged on the above car, truck or vehicle to secure the amount of the repairs thereto and subject to repossession for any unpaid amount.
COLLISION SPECIALISTS, INC. WILL NOT BE HELD RESPONSIBLE FOR LOSS OR DAMAGE TO VEHICLE OR ARTICLES LEFT IN THE VEHICLE IN CASE OF FIRE, THEFT, ACCIDENT OR ANY OTHER CAUSE BEYOND YOUR/OUR CONTROL. COLLISION SPECIALISTS, INC. IS ALSO NOT RESPONSIBLE FOR ANY VEHICLE RENTAL FEES.
Old parts removed from the car will be discarded unless otherwise instructed.
Power Of Attorney
State of Tennessee | County of Madison
By signing this power of attorney, the undersigned insured/claimant does hereby grant Collision Specialists, Inc. Power of Attorney to sign and endorse any checks and/or drafts made payable to the insured/claimant and to release as settlement the insured/claimants claim for and all damages to the insured/claimant’s vehicle.
Date Format: MM slash DD slash YYYY
Signature for Authorization, Mechanics Lien, Power of Attorney