Repair Authorization Form

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This field is for validation purposes and should be left unchanged.

Customer Information

Name(Required)

Email(Required)

Phone(Required)

Vehicle Information

Vehicle Year(Required)

Vehicle Make(Required)

Vehicle Model(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Terms and Conditions

Important: Please check ONLY the Terms & Conditions that you agree to:

I acknowledge that I have reviewed the itemized estimate of damages and/or discussed the necessary repairs with a representative of Italy A&F Auto Repair Inc. I hereby authorize Italy A&F Auto Repair Inc. to perform repairs to the vehicle listed above and to repair any additional hidden or supplemental damage discovered during the repair process.

Terms and Conditions

I understand that pursuant to Section 216.7 of New York State Insurance Law, I have the right to use the total amount of my insurance claim settlement as I choose. In the event of deficiencies in labor rates, labor hours, procedures, or operations not fully covered by my insurance settlement, I authorize Italy A&F Auto Repair Inc. to use its professional judgment to perform a safe, proper, and high-quality repair at posted labor rates.

Terms and Conditions

I understand and agree that Italy A&F Auto Repair Inc.’s final invoice may differ from the Insurance Company’s estimate, including differences in parts, labor, labor hours, or repair procedures. Parts pricing is based on current industry motor guides and supplier pricing and may vary due to availability or market conditions.

Terms and Conditions

I understand that all estimates and invoices are based on flat-rate labor hours, not actual time spent, and that repair techniques are determined by Italy A&F Auto Repair Inc.’s professional judgment.

Terms and Conditions

Permission is granted to perform diagnostic and road testing. Italy A&F Auto Repair Inc. is not responsible for loss or damage due to fire, theft, flood, acts of nature, or other causes beyond its control.

Terms and Conditions

All repairs must be paid in full prior to vehicle release. Vehicles not under active repair are subject to a $225.00 per-day storage fee, including total losses, vehicles not repaired by this facility, or vehicles left more than one (1) day after completion.

Terms and Conditions

Amounts advanced for towing, storage, or sublet services may be subject to reasonable markup. Administrative, lot, cleanup, inspection, or estimate fees may apply. All charges must be paid prior to release.

Terms and Conditions

Prior written notice is required for return of replaced parts. All parts installed are OEM unless otherwise specified in writing.

Signature(Required)

I authorize payment for repairs to be issued directly to Italy A&F Auto Repair Inc. and grant Power of Attorney to endorse insurance checks for payment. Vehicle release is not authorized until payment has been received and cleared.

Photo(Required)

Max. file size: 2 GB.

Take a picture with your phone or upload a picture of your driver license or ID.

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