Work Authorization Form
I hereby authorize Paint Works LLC to inspect, disassemble, prepare, repair, refinish, as well as perform any other work or labor to the vehicle listed below. I hereby authorize the work to be done along with the necessary materials and parts. I grant you or your employees permission to operate the vehicle herein described on streets, highways, or elsewhere for the purpose of testing/inspecting or out sourced repairs. An express mechanics lien is hereby acknowledged on the vehicle listed to secure the amount of the repairs, materials and labor owed. This obligates me as the primary debtor and/or my insurance company through me or direct to pay Paint Works LLC for any and all services, labor, repairs, paint and supplies necessary. I also authorize my insurance company to issue payment directly to Paint Works LLC for any claim and supplement claim. Paint Works LLC is not responsible for the availability of parts or delays in parts shipments beyond their control, nor for the loss, or damage to the vehicle, or items left in the vehicle or on the property in the case of fire, theft or any cause beyond out control. I understand the Paint Works LLC does not accept personal checks. I also understand there will be a 3% fee on all credit/debit card transactions. I also understand the Paint Works LLC is not responsible for any items left inside the vehicle of on the propery.
*
I Authorize and Agree to the stated terms and conditions.
I give Paint Works LLC permission to use photos and/or video of my vehicle or the work performed by Paint Works LLC on their web site or social media.
*
Yes
No
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Year, Make, Model
*
Vin Number
Signature
*
Clear
Date
*
/
Month
/
Day
Year
Date
Submit
Should be Empty:
Now create your own Jotform - It's free!
Create your own Jotform