Work Authorization

Click here to download our work authorization form, or fill out the and submit the online form below.

Contact Info

Owner/Agent Name (required):

Referred By (required):

Address(required):

City (required):

State (required):

Zip (required):

Contact Information


Day Phone (required):

Evening Phone(required):

Cell :

Email(1)(required):

Email(2):

Preferred Method of Contact (check all that apply):
 Text Email Call Back

Vehicle Information


Vehicle Make(required):

Model(required):

Color(required):

Year(required)::

Insurance Company (required):

Referring Agent (required):

Claim Number:

I warrant and represent that I am the owner of the above described vehicle (hereinafter “the vehicle”) or an authorized agent of the owner and that Westside Collision Inc. is authorized to repair the vehicle and provide the necessary services, part, and materials needed for the repair. I further authorize Westside Collision Inc. employees to operate the vehicle on streets and elsewhere for the purpose of testing and/or inspection. I acknowledge and understand that Westside Collision Inc. will have an express mechanics lien on and a security interest in the vehicle until such time as all indebtedness is paid in full. I further agree that Westside Collision Inc. shall not be responsible for loss or damage to articles left in the vehicle in case of fire, theft or any other cause. I further authorize Westside Collision Inc. to be my representative to negotiate with any insurance company/representative regarding the restoration of the vehicle to pre-accident condition and value. Westside Collision inc. is authorized to endorse drafts from insurance company securing payment.


 Owner/Agent acknowledges payment in the form of Cash, Cashier’s Check, Debt, Visa, Master Card, or Discover. No other forms of payment will be accepted. Owner/Agent warrants and represents that Westside Collision Inc. is not responsible for window tint or glass breakage or damage due to removal or work being performed on the vehicle. Owner/Agent acknowledges and understands that payment of insurance deductable is due at Westside Collision Inc. prior to release of the vehicle. Owner/Agent acknowledges and understands that all vehicles left over ten (10) days after scheduled pick-up date will incur a $10.00 per day storage fee. All work left over thirty (30) days will be subject to foreclosure of Westside Collision Inc. Mechanics Lien.

Signature (required):

Date (required):


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 Westside Collision Inc. will have an express mechanics lien on and a security interest in the vehicle until such time as all indebtedness is paid in full. I further acknowledge and understand that:

  • (1) If the vehicle is released by Westside Collision Inc., the vehicle remains subject to Westside Collision Inc. Mechanics Lien and or security interest until such time as all indebtedness is paid in full; and
  • (2) Westside Collision Inc. 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; or
    • (b) Any check, draft or negotiable instrument is 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.

Signature (required):

Date (required):