INSURANCE AUTHORIZATION FORM

Blue Star Brothers Auto Repair

79-59 Cooper Ave Glendale, NY 11385

INSURANCE AUTHORIZATION FORM

    INSURANCE AUTHORIZATION FORM





    Agreement; I hereby authorize BLUE STAR COLLISION CENTER LLC., DBA BLUE STAR BROTHERS AUTO REPAIR, and
    its employees to perform the needed repairs to my vehicle as well as permission to operate the vehicle herein described on
    streets, highways, or elsewhere for the purpose of testing/inspecting. Repairs include parts, labor, materials, and diagnostics.
    If on further inspections, additional parts or repairs are needed, you will be contacted for authorization. BLUES STAR
    BROTHERS AUTO REPAIR. is not responsible for the availability or delay on parts beyond our control, or for the loss, or
    damage to the vehicle, or articles left in the vehicle in the case of a fire, theft, or any cause beyond our control.

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    DIRECTION OF PAYMENT - BLUE STAR BROTHERS AUTO REPAIR

    TAX ID#: 47-1511973

    I do hereby appoint the aforementioned business to accept on my behalf any and all checks, drafts, bills of exchange, and to endorse all such checks, drafts, and bills of exchange for the deposit to the aforementioned business account for credit on my account for repairs on my vehicle which has been released and accepted.

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    Blue Star Brothers Auto Collision Center & Body Shop

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