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Auto Body Repair – Brandywine Coach Works
Auto Body Repair – Brandywine Coach Works

Repair Authorization

Brandywine Coach Works

Repair Authorization Form

Repair Authorization Form

Your Appointment

Please select your service location:
Drop Off Time

Your Contact Information

Name
Name
First Name
Last Name
Address
Address
City
State
Zip/Postal

Your Vehicle

THIS FORM AUTHORIZES BRANDYWINE COACH WORKS, INC. TO PERFORM REPAIRS AND OR TEST DRIVE YOUR VEHICLE, ONCE WE HAVE REACHED AN AGREED PRICE. THE REPAIR PROCESS INCLUDES ACCESSING ALL RELEVANT VEHICLE INFORMATION AND PERFORMING DIAGNOSTIC SCANS. UPON COMPLETION OF THE REPAIRS WE MUST RECEIVE PAYMENT IN FULL EITHER BY CHECK, CASH, CREDIT CARD, MONEY ORDER OR INSURANCE COMPANY DRAFT.

Power of Attorney

TO ENDORSE INSURANCE COMPANY CHECKS: KNOW ALL MEN BY THESE PRESENTS, THAT I HAVE CONSTITUTED, MADE AND APPOINTED JEROD GUERIN MY TRUE AND LAWFUL ATTORNEY TO SIGN AND ENDORSE CHECKS PAYABLE TO MY ORDER FROM THE INSURANCE COMPANY LISTED ABOVE FOR REPAIRS TO MY VEHICLE.

Payment Authorization

I AUTHORIZE THE INSURANCE COMPANY TO MAKE PAYMENT DIRECTLY TO BRANDYWINE COACH WORKS, INC. FOR THE REPAIR WORK BEING PERFORMED ON MY VEHICLE.

Note: This form may take a few seconds to submit. Thank you for your patience.