Fremont Collision Care Center

4878 DAVENPORT PLACE FREMONT, CA 94520

PH: (510) 490-9000 FAX: (510) 490-9090

B.A.R. REG# AF173232

IMPORTANT: No law requires you to get more than one estimate. You have the right to choose your own repair facility

Standard Authorization/Power of Attorney

Estimate of repairs include all parts, labor, handling and diagnosis. If after teardown of the vehicle any initial damage is found, you will be contacted for authorization to proceed. Vehicles waiting for approval more than 10 days will be subject to posted storage of $105 per day. If the automobile is returned to customer before the Authorized Service is performed, a diagnostic and handling charge, not including re-assembly, will be made. If applicable, I authorize Fremont Collision Care Center to act as my agent in negotiating the final cost of repairs with my insurance company. I hereby authorize the repair work described herein to be performed including sublet work and I grant your employee’s permission to operate the vehicle on streets or highways for the purpose of repairing or testing my vehicle. By signing I also acknowledge the receipt of this estimate. I UNDERSTAND THAT I AM RESPONSIBLE FOR PAYMENT OF THE COST OF SAID REPAIRS AND ANY INSURANCE COMPANY MAKING PAYMENT ON MY BEHALF MUST HAVE PAYMENT IN FULL TO FREMONT COLLISION CARE CENTER BEFORE I MAY PICK UP MY VEHICLE. I also agree that in the event that legal action is required, I will pay such additional amounts as the court may fix as attorney fees. If and insurance claim, the undersigned does herby constitute and appoint Fremont Collision Care Center my true and lawful attorney to sign my name such action as may be necessary to negotiate said drafts.

PLEASE NOTE: We DO NOT accept personal checks.

CUSTOMER SIGNATURE: ______DROP OFF DATE: ______

Fremont Collision Care Center is not responsible for items left in the vehicle, theft or damage from matters out of control. If vehicle described herein is not called for within 2 days after notification of completed repairs, storage charges of $105 /day will be made each day after. Also, vehicle that are dropped off, not repaired and picked up, the following charges will apply: administration fee of $90, estimate charge of $105 and any other applicable charges will be included.

I have removed all valuables and personal belongings from my vehicle: ______

Signature

PRIOR DAMAGES: Scratch / Dent X Chipped Paint O

Fuel level: E_____1/4______1/2______3/4______F Initials:______

Please sign here to acknowledge all prior damages:______Date:______