TA Collision Center

Work & Payment Authorization

Work & Payment Authorization Form

📍 12740 Sherman Way, Suite A, North Hollywood, CA 91605 📞 (279) 789-8989

1. Customer & Vehicle Information

Pick from the suggestions or type the full address.
No file selected Upload a photo of your driver's license — JPG, PNG, HEIC, or PDF, up to 15 MB. iPhone photos are auto-converted.

2. Repair & Payment Authorization

I authorize TA Collision Center to perform repairs on my vehicle. I understand and agree that:

  • The shop may operate the vehicle for diagnostics, testing, and delivery.
  • Sublet services may be used when needed.
  • TA Collision Center may receive insurance payments directly and sign related documents on my behalf.
  • I am responsible for all repair costs, including any additional charges not covered by insurance.
  • A mechanic's lien is acknowledged on the vehicle to secure payment.
  • The shop is not liable for personal items left in the vehicle.
  • Disassembled or damaged parts will be discarded unless I request otherwise in writing.
  • If repairs are canceled, I agree to pay teardown, reassembly, and storage fees.
  • Final cost may differ from insurance or initial estimates, depending on actual damage found.

3. Labor & Storage Rates

ServiceRate
Paint & Body Work$85 / hr
Structural Repairs$130 / hr
Frame Straightening$125 / hr
Mechanical Repairs$195 / hr
Electrical Diagnostics / Repair$200 / hr
Paint Materials$85 / hr
Vehicle Storage$300 / day

Storage begins the same minute after notice of total loss or repair completion.

4. Authorization & Signature

I certify that I am the vehicle's legal owner or authorized agent. I have read, understood, and agree to the terms listed above. I authorize TA Collision Center to perform the necessary work and communicate with my insurer.

Sign with your finger, stylus, or mouse.