Repair Authorization

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First Name*
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Vehicle Year*
Vehicle Make*
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Vehicle Repair Authorization
WARRANTY DISCLAIMER: ALL PARTS AND ACCESSORIES ARE SOLD AND ALL REPAIRS ARE PROVIDED BY THE DEALERSHIP AS-IS. THE DEALERSHIP HEREBY DISCLAIMS ALL WARRANTIES, EXPRESS AND IMPLIED, INCLUDING ANY IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE, AND NEITHER ASSUMES NOR AUTHORIZES ANY OTHER PERSON TO ASSUME FOR IT ANY LIABILITY IN CONNECTION WITH THE SALE OF ANY PARTS OR ACCESSORIES OR ANY REPAIRS PERFORMED TO THE VEHICLE. THE ONLY WARRANTIES ON PARTS AND ACCESSORIES OR REPAIRS ARE THOSE WHICH MAY BE OFFERED BY THE MANUFACTURER OR ORIGINAL PARTS DISTRIBUTOR AND ONLY SUCH MANUFACTURER OR DISTRIBUTOR SHALL BE LIABLE FOR PERFORMANCE UNDER SUCH WARRANTIES. CUSTOMER SHALL NOT BE ENTITLED TO RECOVER FROM THE DEALERSHIP ANY CONSEQUENTIAL DAMAGES, DAMAGES TO PROPERTY, DAMAGES FOR LOSS OF USE, LOSS OF TIME, LOSS OF PROFIT OR INCOME, OR ANY OTHER INCIDENTAL DAMAGES. PAYMENT TERMS: I agree to pay for the inspection and repairs I authorize, along with the necessary materials, in Cash or approved credit card upon completion of the Repairs unless the Dealership agrees to other payment arrangements in advance. If I authorize commencement of repairs or disassembly of the vehicle or a vehicle component for diagnostic purposes and do not authorize completion of a repair or service, I understand that a charge will be imposed for disassembly, reassembly or partially completed work and I agree to pay the same. Such charges will be directly related to the actual amount of labor and parts involved in the inspection, repair or service. An express mechanics lien is hereby acknowledged on the vehicle to secure the cost of labor, materials, and other authorized changes. I understand that the Dealership is not responsible for any delays caused by unavailability of parts or shipping by the parts manufacturer or distributor or the transporter, nor is it responsible for loss or damage to the vehicle or articles left in the vehicle in case of fire, theft, hail, wind, or any other cause beyond its control. I hereby grant the Dealership permission to operate the vehicle on streets, highways or public roadways for the purpose of testing and/or inspecting the vehicle. I authorize the retrieval of on-board data as needed to facilitate vehicle repair, as well as sharing that data with the vehicle manufacturer for diagnostic research purposes.
How may we contact you? (Check all that apply)*
- Phone
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Repair Authorization Agreement*
- I have been informed and acknowledge that the repairs and date of completion may be affected by the following factors: A) Discovery of additional damage upon disassembly of damaged area B) Parts availability C) Inspection and Authorization delays from responsible parties (i.e. insurance companies) D) Some electrical or telematic systems cannot be checked/diagnosed until other systems/parts are repaired E) Payment of repairs (Insurance company and/or deductibles).
Electronic Data Agreement*
- I authorize Heyward Allen Toyota to access electronic data from my vehicle as necessary for diagnostic purposes, and to ensure that all applicable systems are functioning properly once the repairs are complete.
Authorized Representative Agreement*
- I certify that I am the true and lawful owner of the vehicle identified above, or the authorized representative of the owner of the vehicle identified above.
Agree to terms*
- I agree to the terms above.
Digital Signature*
Confirm Signature*
Date*
Direction to Pay (to receive insurance payments)
Choose One*
- I authorize the following insurance company to pay Heyward Allen Toyota directly on my behalf for repairs to my vehicle.
- This repair is not related to an insurance claim.
Insurance Company*
Payment Amount*
Digital Signature*
Confirm Signature*
Date*

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Repair Authorization

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