Online Authorization Form.

Fill out the form below and someone on our team will reach out to you as soon as possible.

Repair Authorization Form
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I hereby authorize Mode Collision Repair (MCR), its employees, and is designated third-party providers to complete the repair work on my vehicle. I also authorise the purchase of parts and materials necessary for said repairs. I give MCR Employees and contracted third-party providers permission to operate the vehicle described herein on street, highways, or elsewhere for purpose of testing and inspection.

I understand that MCR is not responsible for loss or damage to my vehicle and/or articles left in vehicle in case of fire, theft, or any cause beyond our control.

Please remove your personal belongings from the vehicle, including your child safety seats, medications, firearms, and anything that may be damaged in exposure to extreme heat. Additionally, once your vehicle is prepared for paint, we will not be able to give you access to it, so please remove anything you think you will need during your repairs. Notify us if your vehicle uses alternate fuel.

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, and/or estimate fees. Any labor, towing, or lift inspection fees must be paid before a vehicle leave MCR. I agree that if I cancel the work authorization before work is completed, I am responsible for paying for all work completed before notice of cancelling, as well as any parts that have been purchased already.

I understand that my bill must be paid in full before my vehicle will be released to me. MCR accepts cash, credit cards, and insurance check payment. Any alternate payment arrangements must be made in advance, in writing, with the owner of MCR. Prior written notice must be given if return of used or damaged parts is desired by the customer.

I grant Limited Power of Attorney to MCR, authorizing them to endorse any checks received on behalf of the vehicle owner(s).

I understand the every effort will be made to complete my vehicle within the timeframe discussed. However, I also understand that MCR cannot be held responsible for delays that occur as the result of parts availability, insurance company requirements, additional damage discovered in the teardown process, weather delays, and other circumstances unforeseen and uncontrollable.

I understand that it is possible that once vehicle teardown begins, additional damage may be discovered. In this case, a supplemental claim will be submitted on my behalf to my Insurance Company and this amount will be included in my final total. If this is not an insurance repair, I understand that I will contacted for authorization in the event that additional work needed changes the estimate price by more than 10%.

I understand and I will incur storage charges at a rate of $200 per day inside and $60 outside i I do not pick up my vehicle within 2 business days of receiving notification that my repairs are complete.

I attest that the designation of MCR as the provider of these repairs is my own choice. I affirm that I am aware that I was free to choose any provider to repair my vehicle.

I certify that I am the true and lawful owner of the vehicle identified above, or the authorized representative of the owner of the vehicle identified above.


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