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

Online Authorization

We've made it fast and easy to authorize repairs to your vehicle online saving you a trip to our shop and getting you back on the road fast.
Complete the form below to complete your repair authorization.

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.
I, the undersigned, hereby authorize Atomize Collision & Customs and its employees to repair my vehicle and to drive my vehicle for testing and/or inspection. If the vehicle is owned/leased by a corporate entity, LLC, or other legal entity, I hereby acknowledge that I have authority to execute this agreement on behalf of that entity and further agree to personally guarantee all costs incurred herein.
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 understand that Atomize Collision & Customs will not be responsible for any auto rental costs during the repair process.
I understand that Atomize Collision & Customs will impose a $50.00 per day storage fee after 72 hours from the completion of the vehicle repair.
I further understand that Atomize Collision & Customs is unable to release any vehicle without payment for all costs of repair, including parts and storage, in full.
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: 3137322e37302e3133342e313636
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