Work Authorization Form

Owner/Agent:

Phone Numbers:

Vehicle:

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. ("WCI") is authorized to repair the vehicle and provide the necessary services, parts, and materials needed for the repair. I further authorize WCI's employees to operate the vehicle on streets and elsewhere for the purpose of testing and/or inspection. I acknowledge and understand that WCI 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 WCI 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 WCI to be my representative to negotiate with any insurance company/representative regarding the restoration of the vehicle to pre-accident condition and value. WCI is authorized to endorse drafts from insurance company securing payment.

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Owner/Agent warrants and represents that WCI 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 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 WCI's Mechanics lien.