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Collision Work Authorization

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First Name*
Last Name*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
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Cell Phone*
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Insurance Company
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How would you like to be updated?*
- EMAIL
- PHONE
- TEXT
How frequently?*
- TWICE PER WEEK
- UPON COMPLETION
Year
Make
Model
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VIN
I hereby authorize Toyota of Irving to repair all damages to the above vehicle, whether or not visible, including any additional repairs deemed necessary by Toyota of Irving and the insurance company. I authorize Toyota of Irving’s employees to operate the vehicle on streets, highways, or elsewhere for the purpose of test driving/inspecting An expressed Mechanic’s lien is hereby acknowledged on this vehicle to secure the amount of the repair thereof, and I agree to pay the reasonable attorney’s fees, court cost, and out of pocket expense incurred by Toyota of Irving in connection with such actions in the event that legal action is necessary. Toyota of Irving will not be liable for any loss or damage to the vehicle, or damage to vehicle, or any components or personal items left in the vehicle, as a result of fire, theft, disappearance, or other cause beyond its control or resulting from any delay in completion of the repairs, whether due to disruptions in the supply or availability of labor, parts, or materials, or other factors beyond Toyota of Irving’s control. Toyota of Irving will not be liable for any damages occurred due to weather condition/act of God (Hail, x______ lightening, rain, snow, etc.) I represent and warrant that I am the owner, or the authorized agent of the vehicle. I acknowledge and agree that before Toyota of Irving shall be obligated to release the vehicle, I agree to pay, or provide satisfaction to Toyota of Irving for the payment of the entire cost, and other amounts due hereunder and if all portion of the repair cost is to be paid by check or draft from the insurance company, I agree to obtain such check or draft from the insured and deliver same to Toyota of Irving, properly endorsed by all payees, including my lien holder (if required) for payment with a valid Texas driver’s license of the maker. I agree, if my personal check is dishonored or returned by my bank, I will pay Toyota of Irving a return check fee of $30.00, and hereby authorize Toyota of Irving to eletronically debit my account for the amount of such check plus the return fee. I agree to pay $45.00 storage fee on non repair / total loss vehicles upon pick up. POWER OF ATTORNEY: In consideration of Toyota of Irving’s performance of the repairs, I appoint Toyota of Irving and its authorized agents as my attorney-in-fact, to endorse any check or draft made payable to me in payment for damages to the vehicle and to sign any release in settlement of the claim for such damage, in conjunction with or a condition to receipt of the proceed is such check or draft. I understand and agree that this power of attorney may not be revoked until Toyota of Irving has received payment in full for the repairs. NOTICE TO PURSUANT TO SECTION 70.001: I acknowledge and agree that if Toyota of Irving releases and delivers the vehicle in reliance upon a check, money order, or credit card transaction on which payment is stopped, or which is otherwise dishonored or rejected for any reason, the lien of Toyota of Irving upon the vehicle shall continue until all amounts due hereunder have been paid in full. Toyota of Irving will have a right to repossess thee vehicle in accordance with the provision of section 9.609 of the Texas Business and Commerce Code.
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Toyota of Irving 32.83845, -96.970081.

Collision Work Authorization

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