Repair Authorization Form

Our intake form helps us gather essential details about your vehicle and the repairs you need. By providing accurate information, we can better assess the damage and prepare an efficient service plan tailored to your needs. Once submitted, our team will review your request and contact you promptly to discuss next steps, including inspection and repair options. Thank you for choosing us for your collision repair needs!

Customer Information

First Name *

Type your first name here

This field is required

Last Name *

Type your last name here

This field is required

Email *

Type your email here

This field is required

Phone *

Type your phone number here

This field is required

Address Lookup

Look up your address using google maps

This field is required

Street Address *

Type your street address here

This field is required

City *

Type your City here

This field is required

State *

Type your state here

This field is required

Zip *

Type your zip or postal code here

This field is required

Vehicle Information

Year *

Type your vehicles year here

This field is required

Make *

Type your car make here

This field is required

Model *

Type your car model here

This field is required

Insurance Company *

Type your insurance company name here

This field is required

Claim Number (If Known)

Type your claim number if you know or have it

This field is required

Received First Insurance Check? *

YES

Check Amount

If you receieved a check, how much was it?

This field is required

Number of people in vehicle at the time of accident?

Type your claim number if you know or have it

This field is required

Select answer for each question

YES

Do you have a wheel lock key or a storage compartment key? *

YES

Are there any warning lights on your dash? *

YES

The insurance check does not have a lien holder that would need to endorse? *

YES

Do you feel your vehicle has been driving differently since accident? *

YES

I prefer and authorize the use of new OEM parts in the repair of my vehicle. *

YES

I prefer and authorize the use of aftermarket parts and/or salvage parts in the repair of my vehicles. *

YES

I authorize insurance payments to be made directly to ATS. *

Read each item and indicate that you agree to the following statements

Auto Tech Services is not responsible for the loss or damage of vehicles, articles, or personal property left in vehicles in case of fire, theft, natural disasters, or any other cause beyond our control. Please remove all personal belongings from your vehicle. *

I Agree

No vehicle will be released until full payment has been made. The deductible and insurance check or proof of loss must be received before the vehicle is released. Ensure that all payees, including lien holders, have endorsed the insurance check before the completion of repairs.

All credit cards accepted, a 3% processing fee will apply. *

I Agree

Vehicles that have sustained extensive damage may require additional repair time and could exceed your rental coverage. Auto Tech Services is not responsible for any rental expenses in such cases. *

I Agree

NOTICE PURSUANT TO SECTION 70.001, TEXAS PROPERTY CODE the customer understands that this vehicle is subject to repossession in accordance with Section 9.609 of the Texas Business & Commerce Code if a written order of payment for vehicle repairs is stopped or dishonored due to insufficient funds, lack of funds, or if the account on which it is drawn has been closed or does not exist.

By signing below, I acknowledge that I have read and agree to the Terms and Conditions.

POWER OF ATTORNEY

Know all persons by these presents: I (or we), the undersigned, hereby appoint Auto Tech Services as my (or our) true and lawful agent and attorney-in-fact. This authorization grants Auto Tech Services the authority to endorse, in my (or our) name, any check or draft issued by the above-named insurance company to cover all or part of the repairs to my (or our) vehicle, as authorized by me (or us).

Auto Tech Services is authorized to take any necessary action to negotiate such check or draft for the purpose of paying for said repairs. I (or we) hereby ratify and confirm any actions taken by the appointed agent and attorney-in-fact under this authorization. *

I Agree

I authorize Auto Tech Services to complete the estimated repair work, including the use of necessary materials. I also grant permission to Auto Tech Services and its employees to operate the described vehicle on streets, highways, or elsewhere for the purpose of completing repairs, testing, and/or inspection. An express mechanic’s lien is hereby acknowledged on the above-mentioned vehicle to secure payment for the repairs performed. *

I Agree

Authorization to Access Vehicle Data: I understand that modern vehicles are complex and that electronic data recorded in vehicle systems may assist in diagnosing necessary repairs and verifying the functionality of applicable systems after repairs are completed. I authorize Auto Tech Services to access this data as part of the diagnostic and repair process. *

I Agree

If the insurance company processing the repairs rejects payment for repair scans and necessary calibrations required by manufacturer guidelines, the vehicle owner will be responsible for covering these costs. *

I Agree

By using this service, you agree that Auto Tech Services may send text messages to the phone number provided. Message and data rates may apply. *

I Agree

Signature *

Use your mouse or touch the display to sign in the box above

Signature is required.

v16.4

Thank you for submitting our form.

Read what our clients say about us

See why drivers trust ATS for collision repair. Read real reviews from satisfied customers who’ve experienced our top-quality service!

Let Auto Tech Services help you get back on the road with confidence. Schedule your repair today!

Address

1856 Lone Star Road | Mansfield, Texas 76063

Contacts

info@atscollision.com
817.477.5511

ATS specializes in collision repair, paint restoration, and frame repair, serving South Arlington, Mansfield, Midlothian, and Alvaredo since 1998. Quality you can trust!

817.477.5511

info@atscollision.com

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