Work Authorization Form

I hereby authorize the repair work herein set forth to be done by Roadside Towing & Collision, together with the furnishing of necessary parts and other material for such repair, and agree; that Roadside Towing & Collision are not responsible for any delays caused by unavailability or delayed availability of parts or materials for any reason; that I shall not hold Roadside Towing & Collision responsible for loss of or any damage to the above vehicle, or articles left therein, in case of fire, theft or other cause beyond our control; that an express mechanic's lien is hereby acknowledged on the above vehicle to secure the amount of repairs thereto; that Roadside Towing & Collision employees may operate referenced vehicle on streets, highways or elsewhere for the purpose of testing and/or inspecting such vehicle.

I do hereby appoint Roadside Towing & Collision to accept on my behalf any and all checks, drafts, or bills of exchange, and to endorse all such checks, drafts, or bills or exchange for deposit to the aforementioned business account for credit on my account for repairs on my vehicle which has been released and accepted.

Roadside Towing & Collision will make arrangements for you with a rental car if you desire one. I have read and agree with the above. I hereby authorize Roadside Towing & Collision to perform the above detailed repairs to this vehicle.

X_______________________________________________________ Date:_________________
Signature of owner or agent

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Name (please print)