Authorization | Kolex Collision Center

We like to be transparent and clear in our work. That is why we invite you to fill out this form to start.

Kolex Collision Center

Work Authorization Form

"*" indicates required fields

Name*

Home Phone*

Cell Phone*

City*

Email*

Street Address*

State*

Zipcode*

Vehicle Year*

Make*

Model*

Vehicle Vin

Insurance company*

Claim #*

How Can We Contact you

By Text?

Yes

By Email?

Yes

REPAIR AUTHORIZATION

I hereby authorize Kolex Collision Center (“Kolex”) to perform the repair work described herein, including all necessary parts, labor, diagnostics, materials, and sublet services required to restore the vehicle identified in this claim. I further grant Kolex Collision Center and its employees permission to operate said vehicle on public or private roads, highways, or elsewhere solely for purposes related to repair, sublet services, testing, inspection, or delivery. I acknowledge and understand that any camera, recording device, or surveillance equipment located in, on, or attached to the vehicle will be disconnected, disabled, or removed prior to the commencement of repairs. Kolex Collision Center assumes no responsibility for the operation, functionality, data, or recordings of such devices. I further acknowledge that certain repairs may require the use of specific materials, procedures, or processes necessary to properly repair my vehicle as outlined in my claim. Kolex may submit documentation and invoices to my insurance carrier requesting reimbursement for such items. I understand that my insurance carrier may decline to pay the full invoiced amount, and I agree to be personally responsible for any unpaid balance. I acknowledge and understand that any determination that my vehicle is deemed a “total loss” is made solely by the insurance company and/or its authorized representatives providing coverage for the vehicle, and not by Kolex Collision Center.

TERMS AND CONDITIONS

By executing this authorization, I expressly acknowledge and agree to the following:

Kolex Collision Center does not provide rental vehicles and is not responsible for rental charges under any circumstances.
Kolex Collision Center shall not be liable for delays caused by parts availability, supplier shipping delays, insurance carrier actions, third parties, or the vehicle owner.
Kolex Collision Center shall not be responsible for any personal property left in the vehicle. I acknowledge that I have removed, or will remove, all personal items prior to repair.
Storage fees may apply if the vehicle is not retrieved within Two (2) days following notification that repairs have been completed.
I am responsible for all amounts not paid by the insurance carrier, including but not limited to deductibles, labor rate differences, material cost differences, and any denied or underpaid charges.
All insurance proceeds issued for repairs under this claim shall be endorsed and remitted to Kolex.
Payment in full is required prior to the release of the vehicle. Kolex Collision Center accepts insurance checks, credit cards, and cashier’s checks.
All credit card payments are subject to a three percent (3%) processing fee. This fee does not apply to debit card transactions.
I hereby authorize Kolex Collision Center to communicate with me via any communication methods they have provided, including phone calls and text messages.

DIRECTION OF PAY AND SUPPLEMENT AUTHORIZATION

I hereby authorize and direct my insurance carrier to issue payment directly to Kolex Collision Center for repairs performed, without my name included on the payment instrument. I acknowledge that this Direction of Pay does not relieve me of financial responsibility should the insurance carrier fail or refuse to issue payment. I further authorize Kolex Collision Center to communicate directly with my insurance carrier regarding my claim and to negotiate and perform any additional or supplemental repairs deemed necessary to restore my vehicle to its pre-loss condition. I authorize Kolex Collision Center to perform such supplemental repairs and to bill the insurance carrier accordingly. Execution of this document constitutes authorization for Kolex Collision Center to perform all approved repairs and to bill the insurance carrier for all original and supplemental work performed. Kolex Collision Center reserves the right, in its sole discretion, to deny, suspend, or cancel any repair services at any stage of the repair process. Kolex Collision Center shall not be liable for any damages, losses, or expenses arising from or related to such denial, suspension, or cancellation, except as otherwise required by applicable law. Any work performed and costs incurred prior to cancellation shall remain the responsibility of the vehicle owner.

ACKNOWLEDGMENT AND AUTHORIZATION

By signing below, I acknowledge that I have read, understand, and agree to all terms and conditions set forth herein. I hereby authorize Kolex Collision Center to commence repairs to my vehicle.

Accepted By:*

Date*

BY CLICKING SUBMIT I AM DIGITALLY SIGNING THIS FORM AND GIVING AUTHORIZATION AND POWER OF ATTORNEY TO KOLEX COLLISION CENTER AS STATED FORTH IN THIS DOCUMENT.