Authorization Form - Union Collision

Repair Authorization Form

New Jersey Tax Identification #222/606/234

Owner(s) Name

Claim #

Insurance Company

Vehicle

Color

Repair Authorization

I authorize Union Collision to perform and or sublet all necessary repairs and replace essential parts involved to bring this vehicle back to the condition it was before this accident occurred.

Supplement & Payment Authorization

I authorize my insurance company, provided above, to directly pay Union Collision all payments and supplements due as a result of my loss.

Full Name

Date

Legal Note

By completing this form, you acknowledge that it serves as your electronic signature and is legally binding.

Repair Authorization Form

Contact

Hours of Operation

Resources

Office Hours