Customer Authorization Form

VEHICLE CHECK IN & REPAIR AUTHORIZATION

7333 E. BUTHERUS DR STE A-200 • SCOTTSDALE, AZ 85260 • 480-405-3557

Customer Information:

Name

Date

Address

Phone

Insurance Information:

Insurance Co. or Customer Pay

Claim Number

Vehicle Information:

Year

Make

Model

Leased or Owned

OFFICE:

License Plate

VIN

Notes

Prior Damage:

Customer Request:

********************Assignment of Rights Authorization********************

I hereby authorize the repair of the above vehicle including all necessary materials and replacement parts. Airpark Collision Center is not responsible for loss damage to this vehicle due to causes beyond their control. Nor is the above repair company responsible for articles left in vehicle that are lost or damaged due to causes beyond their control.

I understand the above repair company cannot guarantee an exact delivery date-these dates are estimates only and the above repair company is not responsible for delays caused by the unavailability of parts or delays due to hidden damage or insurance company approvals.

Parts installed may include OEM, used or aftermarket depending on insurance company. I consent to extraction of data that is stored in vehicle, including its event data recorder, prior to conducting any scan or diagnostic operation. I authorize possible pre &/or post scanning of the vehicle. Removal/replacement of various parts may trigger dashboard warning lights. I understand charges to scan & reset dashboard warning lights, will be additional to amount of estimate, if not paid by insurance I am personally responsible for payment of these services. I also authorize information from the vehicle & diagnostic scan & repair, including customer data to be shared with third parties, including OEM. I am aware that sublet companies may also service/drive my vehicle. I hereby grant permission to the repair company’s employees to operate the above vehicle for the purpose of testing and/or inspecting. Part deposits are non-refundable. I also consent to electronic notification. Final bill may not include all labor, parts, pending supplements or reflect total cost at time of vehicle pick up. Customer may request updated invoice once final insurance supplement is completed.

I hereby assign Airpark Collision Center the right to collect and retain any and all amounts required to repair the above vehicle, including but not limited to, amounts due for labor rate discrepancies, parts price discrepancies and repair procedures from the stated insurance company. This includes collection and deposit of checks made out directly to the above repair company, claimant or insured and checks made jointly to the above repair company and the claimant or insured for this vehicle. I also understand that I am financially responsible for any repairs, parts, etc to my vehicle if payment is denied by the stated insurance company.

Vehicle Owner Signature:

Date:

Pre and Post-Repair Diagnostic Scan Work Authorization Form

This diagnostic work authorization form grants Airpark Collision Center permission to perform a pre and post-repair diagnostic scan on your vehicle as part of the repair process. By accepting this procedure, you acknowledge the terms and conditions listed below. If you choose to decline this procedure, you acknowledge the repair shop will not be held liable for problems with the vehicle that cannot be detected without proper diagnostic scans.

Definition:

Pre-Repair diagnostic scan — this is a complete health check of your vehicle and provides the repair shop (and insurance company, if applicable) a complete report on the number of computer modules on board as well as any diagnostic trouble codes (DTC'S) that could indicate pre-accident and/or accident-related damage. This essential step eliminates unnecessary delays waiting for parts and/or additional insurance authorizations, and identifies issues with the vehicle that could be missed without a pre-repair diagnostic scan.

Post-Repair diagnostic scan — this step ensures that all systems on your vehicle are in proper working order prior to delivery. It is important to note that the majority of DTC's do not result in a malfunction indicator lamp (dashboard light). Failure to perform a post-repair scan by trained professionals with scan tools significantly increases the risk that your vehicle may be returned with malfunctioning, or inoperable, safety and convenience systems, A post-repair diagnostic scan is the single best way to ensure that your vehicle is returned to pre-incident condition.

Data privacy:

In the process of performing a diagnostic scan, Airpark Collision Center will collect important historical vehicle data, including in some cases, the date, time, and mileage of when a DTC was created. This information is helpful in understanding if a problem is accident related or pre-existing. Your acceptance of this procedure grants Airpark Collision Center permission to share this information with third parties, including but not limited to insurance companies and OEM’s. No personally identifiable information is collected during the pre or post-repair scan.

Disclaimers:

Diagnosing vehicles has limitations. In some cases, modified vehicles may give false DTC's. Airpark Collision Center and its employees cannot be responsible for omission or errors caused by the information provided, or not provided, by the customer.
All work performed by Airpark Collision Center will be in accordance with Original Equipment Manufacturer (OEM) specifications and defaults. This includes, but is not limited to, any repairs, calibrations, integrations, programming and set points as indicated by the OEM by way of their designated sources of such information. Airpark Collision Center is not responsible for any damage that results from, or to, aftermarket parts, or modifications from OEM factory specifications.
Variations between vehicles, according to the make model and trim level, may limit the information captured during a pre or post-repair diagnostic scan.
Depending on the condition of the vehicle, and the extent of the damage, and other factors outside the control of Airpark Collision Center a scan tool may not see every system on the vehicle being scanned Airpark Collision Center is not responsible for any changes made to the vehicle after the vehicle leaves the shop.

Initial

While Airpark Collision Center recommends a pre and post-repair scan on every vehicle, it is especially important to perform these functions on newer, highly optioned, heavily damaged vehicles Failure to do so significantly increases the risk to the vehicle owner and occupants.

Yes(initial) I accept having a pre and post-repair diagnostic scan performed on my vehicle, even if my insurance coverage does not pay for these procedures. In some instances, insurance coverage may not be determined until after the diagnostic scans are performed.

No (initial) I decline having a pre and post-repair diagnostic scan on my vehicle, though they were recommended by Airpark Collision Center and the need for them was explained to me. I understand Airpark Collision Center will not be held liable for any hidden damage that could not be detected during the repair process as a result of not having performed a pre-repair scan. I also understand certain systems may not function correctly, or at all, following the repair, and it would be impossible to detect issues with those systems without a post-repair diagnostic scan, I release Airpark Collision Center from all liability for any pre-accident issues, hidden damage or post repair malfunctions that would have been discovered, had consented to having pre and post-repair diagnostic scans performed.

Customer Signature:

Date: