( * fields are required )
Repair Authorization
* Location:    
* Vin Number:  
*this can be found on your insurance ID card.
* Insurance Claim Number:    

Please review and sign the four items below

Inspection & Damage Report Authorization: I authorize disassembly, inspection, test drive and diagnosis for the purpose of providing an estimate of repair costs for this vehicle. If I elect not to have the work done after the estimate of repairs costs is disclosed, I understand that I will incur charges for above services, to include but not limited to:, Disassembly/ Inspection & Damage Report fee of 10 labor hours, storage fees of $85 per day, weatherproofing & diagnostic scan fee as needed. No reassembly will be performed due to the nature of damages. These charges are included in the estimated cost of repairs if you elect to have work performed. This “Inspection Authorization” does not constitute authorization of repairs; the commencement of repairs must be authorized by a separate signature below.
Date:  Signature X: 

Repair Authorization: I warrant and represent that I am the owner of the vehicle or an authorized agent of the owner and that Bates Collision Center ("BCC") is authorized to repair the vehicle and provide the necessary services, parts, and materials needed for the repair. I further authorize BCC's employees to operate the vehicle on streets and elsewhere for the purpose of sublet repairs, testing and/or inspection and delivery or pick-up. An express mechanics lien is hereby acknowledged on said vehicle to secure the amount of repairs thereto. I authorize BCC to be my representative to negotiate with any insurance company/representative regarding the repair of the vehicle. I further authorize any and all payment for repairs to be paid directly to BCC. Some estimates may include the use of aftermarket, reconditioned or used parts. By signing this form, I authorize use of these parts if indicated on the estimate. By signing this form, I am giving consent to receive text messages on behalf of BCC that you may opt out of at any time. I acknowledge that all vehicles left more than three (3) days after completion of repairs will incur an $85.00 per day storage fee.
Diagnostic Scan - In the process of performing a diagnostic scan, BCC will collect important historical vehicle data, including in some cases, the date, time and mileage of when a Diagnostic Trouble Code was created. This information is helpful in understanding if a problem is accident related or pre-existing. It is possible this information will be shared with your insurance company. Your acceptance of this procedure grants BCC permission to share this information with others, including your insurance company. No personally identifiable information is collected during the pre or post-repair scan.
I further agree to pay BCC upon completion of repairs for any and all monies paid by insurance to me (us) either by endorsing over the original insurance checks to BCC or in the form of a personal check, cashier check, debit card or money order. Credit cards are only accepted for amounts not paid by insurance.
Canceled Repairs - If for any reason, I or my insurance company chooses not to repair the vehicle and it is removed from BCC after repair authorization is signed. I understand I will incur additional costs, to include but not limited to: Disassembly/ Inspection & Damage Report fee of 10 labor hours, towing, storage fees of $85 per day, weatherproofing as needed & diagnostic scan fee, the full price of any non-returnable parts, a restocking fee of 25% for returnable parts, and other fees reasonably incurred by BCC.
Possessions Left in Car – I HAVE REMOVED ALL UNATTACHED PERSONAL AND VALUABLE ARTICLES from my vehicle. BCC is not responsible for possessions left in my car.
Acts of God - In the case of damage caused by wind, hail, flooding or other “Acts of God,” I agree to file with my own insurance company. I understand BCC is unable to keep all vehicles under cover or otherwise protect from these exposures and is not responsible for these types of losses.
I have read, acknowledge and agree to all Terms and Conditions above and I hereby give Bates Collision Centers authorization to repair my vehicle:
Date:  Signature X: 

Notice Pursuant to Sec. 70.001, Texas Property Code: I am the person or agent acting on the behalf of the person, who is obligated to pay for the repairs of the motor vehicle herein described. I understand that this vehicle is subject to repossession in accordance with Sec. 9.609, Texas Business and Commerce Code, if a check, money order or credit card transaction for repair on the vehicle is stopped, dishonored because of insufficient or no funds, or because the drawer or maker has no account, or account on which it is drawn has closed.
Signature X: 

Power of Attorney: For consideration of repairs made to this vehicle I hereby grant my Power of Attorney to Bates Collision Centers to endorse any insurance checks/drafts issued by the insurance company covering said repairs to my automobile authorized by myself in whatever manner is necessary to place checks or drafts, for this repair only, into a cashable position.
Signature X: 


© Copyright 2004-2017 Bates Collision Centers, Inc. - All Rights Reserved :: Ph.281.428.2209 :: Fax.281.422.0532
3219 N. Main, Baytown, Tx 77521 :: info@batescc.com