B & E Auto Service
14900 Brighton Road
Brighton, CO 80601
(303) 659-4906 fax
FEDERAL TAX ID # 84-1484767
Standard Authorization/Direction to Pay
Estimates or repairs include all parts, labor, handling and diagnosis. If on closer analysis it is found that additional repairs are necessary, you will be contacted for authorization to proceed. If automobile is returned to customer before Authorized Service is performed, a diagnostic and handling charge, not including re-assembly, will be made. If applicable, I authorize B & E AUTO SERVICE to act as my agent in negotiating the final cost of repairs with my insurance company. I hereby authorize the repair work described herein to be performed, including sublet work, and grant you or your employees permission to operate the vehicle on streets or highways for the purpose of repairing or testing, and acknowledge receipt of this estimate. I UNDERSTAND THAT I AM RESPONSIBLE FOR PAYMENT OF THE COST OF SAID REPAIRS and agree that in the event legal action is required I will also pay such additional amount as the court may fix as attorney fees. If an insurance claim, the undersigned does hereby constitute and appoint B & E AUTO SERVICE my true and lawful attorney to sign my name on any insurance drafts covering any authorized repairs to my automobile and to take such action as necessary to negotiate said drafts. I AUTHORIZE THE INSURANCE COMPANY TO ISSUE PAYMENT DIRECTLY TO THE SHOP FOR ALL SUPPLEMENTAL REPAIRS.
Original Amount $
Supplemental Amount $
Total Due $
OFFICE USE ONLY
B&E Auto Service agrees to perform repairs in which serve to restore the damaged vehicle to its preloss condition relative to safety, function and appearance and further agrees to warranty workmanship, including refinishing, in writing, for a period of not less than one year from date of completion of repairs.
I hereby authorize the estimated repair work to be done along with necessary materials. You and your employees may operate vehicle for purposes of testing, inspection or delivery at my own risk. An express mechanic’s lien is acknowledged on vehicle to secure the amount of repairs thereto. B&E Auto Service will not be held 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.
Accepted forms of payment include: cash, check, DEBIT card or insurance check.