WORK AUTHORIZATION

CUSTOMER INFORMATION

VEHICLE INFORMATION

INSURANCE INFORMATION

PLEASE TAKE NOTICE OF ALL CAR COLLISION, INC.'S ("ACC") ASSIGNED INTEREST IN THESE PAYMENTS & REMIT PAYMENT

• I, the owner of the above described vehicle (the “vehicle”) or an authorized agent of the owner, agree that the above described insurance company shall pay All Car Collision, Inc. (“ACC”) directly for the sum of all repairs to the above described vehicle in connection with the above identified Claim #. I agree to assume responsibility for the amount due should payment not be made to ACC within 30 days.
• Power of Attorney: I do hereby appoint ACC as my attorney in fact to accept on my behalf any and all checks, drafts, or bills of exchange for deposit to ACC’s account for credit on my account for repairs on my vehicle which has been released and accepted. I hereby give ACC, and its agents and representatives the right and authority to endorse the name of owner on all joint checks, sign all checks, and deposit said checks in the bank account of ACC. This Agreement does not relieve the owner of owner’s responsibility to pay all debts due.
• I hereby authorize ACC to be my representative to negotiate with any insurance company or its representative regarding the restoration of the vehicle to pre-accident condition and value. ACC is authorized to endorse drafts from the above described insurance company. I assign ACC all payments I would have a right to receive from the above described insurance company that would be paid to satisfy all repairs (including parts and labor) to the vehicle, including but not limited to supplemental damage checks.

PAYMENT AGREEMENT

As indicated by my initials, I acknowledge that I have read & agree to all terms above.

NOTICE PURSUANT TO TEXAS PROPERTY CODE § 70.001

I warrant and represent that I am the owner of the above described vehicle or an authorized agent of the owner. I acknowledge and understand that All Car Collision, Inc. (“ACC”) will have an express mechanic’s lien on and a security interest in the vehicle until such time as all indebtedness is paid in full. I further acknowledge and agree that: (1) if the vehicle is released by ACC, the vehicle remains subject to ACC’s Mechanic’s Lien and/or security interest until such time as all indebtedness is paid in full; and (2) because the vehicle is subject to repossession in accordance with Section 9.609 of the Texas Business and Commerce Code, ACC has the right to repossess and sell the vehicle in satisfaction of its lien or security interest if: (a) the indebtedness remains unpaid for 30 or more days; (b) any check, draft or negotiable instrument is declined, stopped, or dishonored for any reason; or (c) the drawer or maker of the order has no account or the account on which it is drawn has been closed.

As indicated by my initials, I acknowledge that I have read & agree to all terms above.

ADDITIONAL TERMS & CONDITIONS

• I warrant and represent that I am the owner (or authorized agent of owner) of the above described vehicle (hereinafter “the vehicle”). I authorize All Car Collision, Inc. and its staff, employees, owners and contractors (collectively, “ACC”) to perform the required repair work to the vehicle, including any hidden damage ACC may find during the repair process, along with the necessary materials and parts, including but not limited to those specified or made necessary in accordance with the repair estimate, insurance estimate, supplements (if any), or otherwise specified in writing.
• I grant ACC permission to operate the vehicle herein described on streets, highways or elsewhere for the purpose of diagnosing, testing, and/or inspection. I agree that: (a) ACC is not responsible for loss or damage to the vehicle, or articles left in the vehicle, in case of theft, fire, accident, pandemic, acts of God, or any other cause beyond our control; (b) ACC is not responsible for delays caused by unavailability or delay in shipment of, parts by supplier or transporter; (c) all parts removed from the vehicle will be considered the responsibility of ACC to dispose of as they deem necessary; and (d) an express mechanic’s lien is hereby acknowledged on the vehicle to secure the amount of repairs thereto.
• STATEMENT OF DISCLAIMER: ACC provides a Lifetime Limited Warranty on each body and collision repair it performs, and ACC expressly disclaims all other warranties, either express or implied, including any implied warranty of merchantability or fitness for a particular purpose. See all warranty details, benefits, disclaimers, exclusions, and limitations, which are incorporated at length herein, at: www.allcartx.com/warranty/
• RESTOCKING FEE NOTICE: We will order parts as soon as we can to expedite repair of the vehicle. Thus, once the parts have been ordered, there is a 25% restocking fee for any parts that must be returned, and ACC may additionally charge any actual return shipping and/or freight charges that must be paid in full before the vehicle is released.
• EVALUATION, TEAR DOWN AND WRITTEN ESTIMATE FEE WITHOUT REPAIR: $195 fee. ACC incurs substantial labor costs in tearing down, evaluating and generating an estimate of the vehicle. If the customer then chooses not to repair the vehicle at ACC, this fee is due and must be paid in full before the vehicle is released.
• I agree that, prior to release of the vehicle, payment and any supplemental damage charges shall be paid in full, and if applicable, all payees (including all lien holders) will endorse the insurance check prior to completion of repairs. There is a $50 fee for checks returned NSF or subject to a stop payment.
• I understand that: (a) ACC's final invoice for repair of the vehicle may not match the insurance company's estimate as to parts, labor or procedures used to repair my vehicle; (b) parts prices are based upon estimating software; however, prices may vary due to currency fluctuation or varying supplier costs; (c) repair techniques employed are based upon ACC's judgment as to the best means of effecting a high quality repair; (d) ACC's labor charges are based upon hourly time allowances as given by estimating software, and their experience, and may be more or less than the amount of actual time; (e) ACC estimates and final invoices are based upon flat rate hours as is customary in the collision repair industry, not actual time spent on repairs; and (f) a flat rate hour is a unit of time given for a certain repair operation and that actual time spent on a repair operation can vary greatly from the flat rate time given to a labor procedure depending on technician experience and equipment provided and/or training.
• Vehicles towed or driven in, then deemed a total loss, or moved to another facility for any reason by the customer or insurance company may be subject to administrative, lot, debris cleanup charges or estimate fees. Any labor, towing or lift inspection fees must be paid before a vehicle leaves ACC. Prior written notice must be given if the customer wants used or damaged parts returned; for core parts, a core part fee of $100 is due before taking possession of the part. In the event that an insurance company (a) fails to provide an estimate and/or (b) does not agree on a price for the cost of either the initial estimate or supplement within 10 business days of the vehicle arriving at ACC, then there will be a storage charge of $35/day beginning with the day the vehicle arrived at ACC.
• Storage charges will accrue 5 days after notification of the completion of repairs at a rate of $35/day. Failure to make payment within 30 days of notification of the completion of repairs will result in the commencement of the auction process to satisfy the implied mechanic's lien.
• I also agree that ACC or any other servicer of this account may use any contact information I provide to contact me.
• I authorize ACC to disassemble my vehicle for the purpose of preparing a full estimate of the repair. A written estimate delivered via email using the email address I've included above is acceptable to me.
• AUTHORIZATION TO REPAIR: Following my estimate, I hereby authorize ACC to complete the necessary repairs to my vehicle. An ACC staff member will provide me with an oral/written evaluation. I understand that payment in full will be due upon release of the vehicle, including any supplement charges. I hereby grant you and/or your staff permission to operate my vehicle on streets, highways, or elsewhere for the purposes of testing, inspection or sublet repairs, and delivery or pick up. An Express Mechanic's Lien is hereby acknowledged on above vehicle to secure the amount of repairs thereto. I will not hold ACC 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 authorize any and all supplements to be paid directly to ACC.

As indicated by my initials, I acknowledge that I have read & agree to all Additional Terms & Conditions.

E-SIGNATURE AGREEMENT

By typing my name and contact email address below, I confirm that I agree to the electronic submission of this Work Authorization to ACC and I accept that the information provided constitutes my legally binding digital signature.

Use your finger, mouse, or stylus to sign your signature in the box above.