1705 Reinhardt College Pkwy
Canton, GA 30114
Ph) 770-720-2066

Vehicle Repair Authorization

We’ve made it simple to authorize repairs to your vehicle online.
Complete the required information below, click the boxes to agree to the statements and sign with your finger or mouse before submitting.

Customer Information
Vehicle & Insurance Information
Clicking the boxes indicates you have read and agree to the following statement(s):

I understand that my insurance company may only pay for aftermarket (A/M) or used/salvaged parts. lf this is the case; I may choose to use OEM parts at my own expense. lf you have elected and authorized the use of AM and/or salvage parts in the repair of your vehicle, you accept the full responsibility for their use. Therefore, you agree and acknowledge that we accept no liability for the use of AM parts and/or salvage parts in the repair of your vehicle, and you agree to indemnify us and hold us harmless for any and all actions, claims, or issues arising from or connected to the use of aftermarket parts and/or salvage parts in the repair of your vehicle.
Atomize Collision & Customs is not responsible for loss or damage to vehicles, articles, or personal property left in vehicles, in case of fire, theft, natural disasters or any other cause beyond our control. Please remove all personal belongings from your vehicle.

No car will be released until full payment is made. Deductible and insurance check or proof of loss must be received before vehicle will be released. Be certain all payee's(including lien holders) have endorsed the insurance check prior to completion of repairs.

The maximum payment using a credit or debit card shall not exceed $3000.00
I understand that an express mechanic's lien is acknowledged on the vehicle to secure the amount of repairs .
l understand that Atomize Collision & Customs will not be responsible for theft of vehicle or missing articles left in vehicle such as but not limited to ipods, cameras, sunglasses, credit cards, money, CD's, etc. Please remove all items from vehicle before or when you drop off your vehicle for repairs.
I authorize Atomize Collision & Customs to complete estimated repair work to be done along with the necessary materials. And hereby grant you, and/or your employees permission to operate the vehicle herein described on streets, highways or elsewhere for the purpose of completing repairs, testing and/or inspection. An express mechanic's lien is hereby acknowledged on above vehicle to secure the amount of repairs thereto.
Authorization to Access Vehicle Data: I understand that modern vehicles are complex and that electronic data recorded in vehicle systems may help to diagnose necessary repairs and to confirm that applicable systems are functional after repairs are performed. I authorize Atomize Collision & Customs to access this data as part of the diagnostic and repair process.

In the event of the insurance company processing repairs reject payment for repair scans and necessary calibrations to your vehicle as per manufacturer guidelines, these repair scans and calibrations are required and will be paid by the vehicle owner.
I am responsible for payment in full for the repairs of my vehicle, either before or after completion of work. I understand that while insurance may cover some or all repairs, that is a separate agreement between me and my insurance company and I personally am responsible for all costs, including parts, repair and storage, under tthis Agreement.
Payment options: *Cash, *Debit Card, *Credit Card or *lnsurance Checks (endorsed over to Atomize Collision & Customs)
**Sorry, No personal checks, or Amex.

I authorize my Insurance company to pay Atomize Collision & Customs direct for all supplemental and original repairs. I authorize Atomize Collision & Customs to endorse my name to any insurance checks received for payment for repairs of my vehicle.
By using this service, you agree that Atomize Collision & Customs may text you at the number provided. Message and data rates may apply.
By drawing your signature in the space provided above, and clicking the "complete authorization" button, you are consenting to use electronic records and signatures in connection with this transaction, confirming your name displayed above is correct and you understand and agree to the statements above as well as our Terms and Conditions for Use in Document Executions. Your electronic signature will be just as enforceable as signing the same document using a handwritten signature.
Digital Signature: 3137322e37302e3137342e313236
IP Address: User Agent: CCBot/2.0 (https://commoncrawl.org/faq/)
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