AUTHORIZATION FOR REPAIRS

Name ______________ Repair Order No.________________

Date Vehicle Received_____________________________ License No.____________________
VIN____________________________________________ Mileage_______________________

Please check your preferred contact method:

o E-mail Address______________________________________________
o Home Phone No._____________________________________________
Please fax to
801-359-
o Work Phone No._____________________________________________
3306. Thank
o Cell No.____________________________________________________

STATEMENT OF POLICY
Ken Garff Body Shop is referred to as “Ken Garff” throughout this document.

Acceptable methods of payment include: cash, properly endorsed insurance company checks, credit cards, or
any combination of these methods. WE DO NOT ACCEPT PERSONAL CHECKS.

No vehicle will be released until the repairs are paid in full or; until we have received a firm commitment from
an insurance company to pay in full for repairs. I understand that I am responsible for any applicable deductible
adjustment for depreciation and/or betterment amounts.
CUSTOMER INITIALS_________

Ken Garff is not responsible for loss or damage to your vehicle, including, but not limited to: losses from fire,
theft, accident, or other circumstances beyond our control. You should remove all valuables from your vehicle
before leaving it to be repaired; Ken Garff will not be responsible for any items left inside or on your vehicle.
Examples of valuables include, but are not limited to: cash, checks, jewelry, CD’s, tapes, and portable or easily
removed sound and CB systems. We also suggest that you remove blankets and clothing from the vehicle. I
have removed all valuables from my vehicle before leaving it with Ken Garff Body Shop.
CUSTOMER INITIALS__________

**Parts prices are subject to invoice** Authorized and Accepted.

Ken Garff is hereby authorized to make the specified repair(s). I understand that payment will be due upon
release of the vehicle, including additional supplemental damage charges. Should there be any unpaid balance;
interest will accrue at the rate of 21% per annum. I also agree to pay any attorney and/or collection fees and
court costs incurred in the collection or settlement of my obligation. I hereby grant Ken Garff and/or its
employees permission to operate the vehicle herein described on streets, highways, or elsewhere for the purpose
of sublet, testing, and/or inspection. An express mechanic’s lien is hereby acknowledged on the above vehicle
to secure the amount of repairs thereto in the vehicle in case of fire, theft, accident, or any other circumstances
beyond our control. Old parts removed from the vehicle will be discarded unless otherwise specified. I
authorize the insurance company to make any and all payments directly to Ken Garff. I do hereby appoint Ken
Garff as my attorney in fact to accept on my behalf any and all checks, drafts, or bills of exchange. Ken Garff
may also endorse all such checks, drafts, or bills of exchange for deposit to Ken Garff Body Shop’s bank
account to apply as credit on my account for the repair to my vehicle.

AUTHORIZED BY___________________________________________DATE___________