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Please check each box to authorize service *

I hereby authorize Art Moehn Collision Center to DISASSEMBLE AND COMPLETE the necessary repairs to my vehicle. I understand that I am entitled to a written estimate/evaluation of the damage, upon request.

I authorize Art Moehn Collision Center to operate my vehicle for the purpose of testing, inspecting or sublet repairs, pickup or delivery.

I authorize Art Moehn Collision Center to negotiate with insurance companies on my behalf.

DIRECTION TO PAY: I authorize all insurance payments be made to Art Moehn Collision Center. I understand that I am responsible for all deductible payments and any pre-issued payments authorize all supplement amounts be paid to Art Moehn Collision Center. An express mechanics lien is hereby acknowledged on the above vehicle to secure the amount of the repairs.

I will not hold Art Moehn Collision Center liable for loss or damage to the vehicle in case of fire, theft or accident. ART MOEHN COLLISION CENTER IS NOT RESPONSIBLE FOR ANY PERSONAL ARTICLES LEFT IN THE VEHICLE. I ACKNOWLEDGE I HAVE REMOVED OR WILL REMOVE ALL PERSONAL ARTICLES FROM MY VEHICLE.

In order to diagnose necessary repairs, I authorize Art Moehn Collision Center to access the vehicle's electronics data.

Due to current issues with parts availability, materials and labor shortages, ART MOEHN COLLISION CENTER WILL NOT BE RESPONSIBLE FOR RENTAL CHARGES BEYOND INSURANCE COMPANY APPROVED PERIOD OR POLICY LIMITS.

This authorization is subject to your consent to electronic transactions and disclosures. You agree that your electronic authorization has the same force and effect and is the legal equivalent of your manual authorization signature.

Checking this box, and the above boxes, indicates that YOU HAVE READ, UNDERSTAND AND AGREE to the above terms.