Dale Peterson Auto Body

Repair Authorization

The undersigned, hereafter called “insured” for the consideration of repairs made to insured’s above described automobile, does hereby grant DALE PETERSON BODY SHOP, LLC Power of Attorney to sign or endorse any checks and/or drafts made payable to insured, and any releases thereunto, as settlement for insured’s claim for damages to the above described automobile.

I hereby authorize the repair work to be done along with the necessary materials. You and your employees may operate vehicle for purpose of testing, inspection, or delivery at my risk. An express mechanics lien is acknowledged on above vehicle to secure the amount or repairs thereto. It is understood that you will not be held responsible for loss or damage to vehicle or articles left in vehicle in case of fire, theft, or any other cause beyond your control. It is also understood that full payment for repairs is due upon release or delivery of vehicle, including supplemental charges.

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