New Service Request

Repair / Job Opportunity

Please complete and submit the full authorization for repair using the form below.

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Full Name

Cell Phone Number

Vehicle Year

Vehicle Make

Vehicle Model

Vehicle Mileage

VIN

Please describe what needs repaired on vehicle:

Claim #

Deductible Amount $

Total Repair Amount $

Insurance Pay $

AUTHORIZATION TO REPAIR: I hereby authorize repair work to be done with the necessary material and agree: that you are not responsible for any delays caused by unavailability or delayed availability of parts or materials for any reason. An express mechanic’s lien is hereby acknowledged on the above vehicle to secure the amount of repairs. I grant permission to operate my vehicle for the purpose of testing and inspection. JZS Auto Body & Service is NOT responsible for any personal items left in the vehicle during the time of repair.

I, as signed below, authorizes JZS Auto Body & Service to do all the repair to the vehicle that was discussed, and written on estimate. I acknowledge by filling out my name below and submitting this form that it serves as my official signature. First Name Last Name

You have the right to retain your damaged parts. I waive my right to retain my damaged parts. (Initial here please)

Direction of Pay: I hereby authorize payment to be made directly to JZS Auto Body & Service regarding repairs to the above vehicle and claim.

New Service Request

Repair / Job Opportunity

Please complete and submit the full authorization for repair using the form below.

Sign up to our newsletter

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