I do hereby authorize Coach Specialists of Texas, Inc., to transport my unit described above, to an authorized facility for the purpose of additional repairs if needed, and I will hold them harmless for any and all damages that may occur during this transport. I further acknowledge that my insurance company would be the responsible party, if necessary.

* I further acknowledge the vehicle has current inspection stickers and is within the legal guidelines to be towable or drivable depending on type/class of the vehicle. This includes but is not limited to all working headlights, turn signals, brake lights, windshield wipers, and brakes. All tires must be in good condition and within legal limits with a minimum of 4/32 of tread depth.

Please keep in mind the accepted payment terms of our policy which consist of the following: We accept all Major Credit Cards. A 3.5% service fee, assessed by the third-party merchant provider, is applied to all Credit/Debit card transactions. Personal checks are accepted up to $1,000.00. Certified Checks, Cashier’s Checks, Cash, and Money Orders are accepted with no additional fee applied. We appreciate your business!

Due to the complexity of the repairs and the quality of work required we are unable to guarantee a specific delivery date. Power of Attorney: For the consideration of repairs made to the vehicle, I hereby grant my Power of Attorney to sign or endorse any checks and/or drafts made payable to me and any release thereto as settlement for my claim for damages to this vehicle.

The customer is responsible for the complete repair bill including both the insurance deductible portions. It is the customer’s responsibility to inform their service representative when payment is to be made with an insurance check and whom the check is made out to. Please Note: If the lien holder is a payee on the check, the vehicle will be taken to the lien holder for inspection at which time they will endorse the check. All deductibles and customer pay repairs are to be paid prior to the delivery of the vehicle. Payment in full of the balance is required before the vehicle is delivered. In some cases, a storage fee of $30.00 per day may be incurred. Please remove any personal items from your vehicle.

By signing your name electronically on this Authorization Form, you are agreeing that your electronic signature is the legal equivalent of your manual signature on this Authorization Form. By selecting “Submit” you consent to be legally bound by the terms and conditions on this Authorization Form.