INSURANCE AUTHORIZATION FORM Blue Star Brothers Auto Repair 79-59 Cooper Ave Glendale, NY 11385 (718) 383-6734 INSURANCE AUTHORIZATION FORM I agree on terms and condition INSURANCE AUTHORIZATION FORM Insured Name Street Address City State ZIP Email Address Phone Number Make of your Car: Select MakeAcuraAudiBentleyBMWBuickCadillacChevroletChryslerDodgeFiatFordFerrariGMCHondaHyundaiInfinitiIsuzuJaguarJeepKiaLand RoverLexusLincolnMaseratiMazdaMercedes BenzMiniMitsubishiNissanPorscheSAABSaturnScionSmartSubaruSuzukiTeslaToyotaVolkswagenVolvoOther Year of your Car: Select Year202320222021202020192018201820172016201520142013201320122010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986 Model of your Car: Color: Select ColorRedWhitePearl WhiteBlueBlackBrownYellowGreenGreySilverOther Insurance Company: Insurance CompanyGEICOPROGRESSIVEALL STATESTATE FARMLIBERTY MUTUALNATIONAL GENERALNATIONALUTICAUTICA NATIONALTRAVELERSUSAACHUBBCOUNTRY WIDETHE GENERALNATIONWIDEESURANCEFARMERSTHE HARTFORDMETLIFESAFECOSENECAEMPIREERIEMAPFRERLISELECTIVEFIREMANS FUNDS INSURANCEFARM INSURANCESENTRYINTERSTATE INDEMNITYINTERBOROKANSAS CITY FIRE AND MARINE INSURANCELIBERTY MUTUAL FIRE21st CENTURYWESCOLM INSURANCENOVAHANOVERAMERICAN TRANSITHARLEYSVILLEHEREFORDINFINITYLANCERCINCINNATIKINGSTONEZURICHFOREMOSTMAIDSTONEAMERIPRISEBERKLEYMID CENTURYAMICABERKSHIREAmGUARDOTHER Other Insurance Co: Claim Number: 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. Initialize Box Below 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. Sign Box Below Press Again To Send Blue Star Brothers Auto Collision Center & Body Shop Satisfaction Guaranteed Call us today 718-383-6734 book an appointment online