Digital Authorization Form Authorization Form Full Name: Job Number: Authorization Details: I hereby represent that I have the authority to authorize such work including the disassembling necessary to make the repairs. I hereby grant to Northside Collision & Paint Center and its employees permission to extract data that is stored in the vehicle, including its event data recorder, prior to conducting any scanning or diagnostics operation. Northside Collision & Paint Center agrees that access to such data will be for the limited purpose of conducting vehicle diagnostics and/or repairs. I hereby grant to Northside Collision & Paint Center and its employees permission to operate the vehicle on streets, highways, or elsewhere for the purpose of testing and/or inspection. I agree that Northside Collision & Paint Center may repair my vehicle at the Northside Collision & Paint Center facility to which I deliver it or at any other Northside Collision & Paint Center facility(ies). I agree that Northside Collision & Paint Center shall not be liable for failure to perform any of the authorized services in the event of strikes, lockouts, calamities, acts of God, unavailability of supplies or other events over which Northside Collision & Paint Center has no control, for so long as such event continues and for a reasonable period of time thereafter. I agree that I am responsible for full payment for the repairs, including any deductible and customer pay portion, upon the earlier of the completion of repairs, or upon delivery or acceptance of the vehicle. I acknowledge and agree that in some cases, a storage fee of $30.00 per day may be charged by Northside Collision & Paint Center. I acknowledge that no representative of Northside Collision & Paint Center has made any statements that I have relied on regarding whether I have insurance on, or whether insurance is going to pay for repairs to the vehicle. I accept responsibility to pay the repair bill, in full. I acknowledge that Northside Collision & Paint Center does not guarantee the amount of its estimate of repair costs due to its inability to tell exactly what is necessary before disassembling and inspecting. I acknowledge that if closer analysis reveals that additional repairs are necessary, I will be contacted for authorization of any additional repair charges. If new parts listed in the attached repair order are not available, Northside Collision & Paint Center reserves the right to repair such damaged or worn parts when possible. The difference between the part price and the labor required will be adjusted accordingly. I agree that this Authorization of Repairs contains the entire understanding of the parties relative to the referenced repairs. No change to any term or provision of this Authorization will be valid or binding unless agreed to in writing by Northside Collision & Paint Center. No waiver of any of the terms of this Authorization will be valid unless signed by Northside Collision & Paint Center. I agree to pay reasonable attorney’s fees and other enforcement expenses in the event that legal action becomes necessary to enforce this contract. To secure payment for the repairs, I hereby grant to Northside Collision & Paint Center an express mechanic’s lien on the vehicle. Signature: Clear Signature Additional Authorization Details: Power of Attorney I hereby authorize Northside Collision & Paint Center to endorse any insurance draft in my name received by Northside Collision & Paint Center which is paid by any insurance company for the repairs performed and completed on the vehicle listed above. Statement Regarding Personal Belongings I certify that all belongings in the vehicle listed above being repaired by Northside Collision & Paint Center have been removed by me or my designee and I will not hold Northside Collision & Paint Center responsible for any items in my vehicle that are stolen or damaged by theft, fire or acts of God. I or my designee have checked the GLOVE BOX, CONSOLE, TRUNK, UNDER SEATS and any other such areas containing personal property. I have removed all removable items such as CD’S, CD PLAYER, RADAR DETECTOR, PHONE, DETACHABLE STEREOS, JUMPER CABLES, GOLF CLUBS, SUNGLASSES AND ALL OTHER PERSONAL ITEMS. Direction to Pay I authorize the insurance company to pay the cost of initial repairs and any subsequent supplements directly to Northside Collision & Paint Center whose receipt shall be sufficient to satisfy this claim. Second Signature: Clear Second Signature Submit