Authorization

Three In One Auto Body and Mechanic, INC

VEHICLE REPAIR AUTHORIZATION AND CUSTOMER AGREEMENT

Customer Authorization and Agreement

I, the undersigned, authorize the repair work on my vehicle, as specified, to be performed by Three In One Auto Body and Mechanic, INC ("the Repair Shop"). I understand and accept the following terms and conditions regarding the repair and payment of my vehicle.

Care, Custody, and Protection (CCP) Fee

A Care, Custody, and Protection (CCP) Fee will be charged as follows:

• $220 per day for vehicles stored inside
• $200 per day for vehicles stored outside

These charges begin on the day the vehicle is dropped off at the Repair Shop. In the event that the vehicle is deemed a total loss, this CCP fee will apply from the date of drop-off until the date of removal by the customer or their insurance provider.

Authorization for Parts and Cancellation Terms

I authorize the Repair Shop to order necessary parts for repairs. Should I cancel the repairs after parts have been ordered, I agree to the following:

• Restocking Fee: A 30% restocking fee will apply to all parts ordered.
• Non-Returnable Parts: If any part ordered is non-returnable due to its status as an electronic or special order, I agree to pay for the part in full, and that part will be provided to me.

Repair Agreement

• The Repair Shop is not responsible for loss or damage to my vehicle, or any articles left in the vehicle, due to fire, theft, or any cause beyond its control. The Repair Shop is also not responsible for delays caused by unavailability of parts or other delays beyond its control.
• I grant permission to the Repair Shop and its employees to operate my vehicle on streets, highways, or elsewhere as necessary for testing and/or inspection.
• An express mechanic's lien is hereby acknowledged on the above-described vehicle to secure payment for all repair work done.
• Old Parts: Old parts removed and replaced will be discarded unless otherwise specified by me before repairs begin.

Payment and Insurance Responsibilities

All repair costs, including deductibles and any customer-paid expenses, must be settled in full before the vehicle is released. If my insurance issues a direct payment to me instead of the Repair Shop, I acknowledge that I am solely responsible for paying any outstanding balance.

If repairs are canceled or partially completed, the Repair Shop may charge for teardown costs, parts ordered, and any labor required to reassemble the vehicle.

Estimate & Rental Policy: A fee of $150 applies for writing estimates. Repair completion times aren't guaranteed—delays may occur due to insurance approvals, parts availability, or other factors beyond our control. If you need a rental or alternative transportation, that expense is your responsibility and may not be reimbursed by the shop.

By my signature below, for good and valuable consideration (including but not limited to the extension of credit to me), I hereby assign, transfer and convey to Three In One Auto Body and Mechanic, INC (hereinafter "Provider"), all of my rights, title and interest in and to auto repair reimbursement in whatever form, including but not limited to any insurance coverage under property damage, comprehensive, collision, windshield and/or any coverage otherwise payable to me through auto insurance. This payment shall not exceed any indebtedness to the above named assignee and I acknowledge that I will timely pay any indebtedness owed by me to the assignee that is not otherwise satisfied by the above-mentioned assigned proceeds. I also acknowledge that any expenses not covered under my insurance policy will be my responsibility.

I further authorize the Provider to negotiate, collect and settle any claim with any insurance carrier or other third party payor with regard to these services, which authorization shall include authority to: (1) request and receive from any insurer or any other party any and all documentation and records that I am empowered to request regarding this claim, including, without limitation, a statement of coverage, policy declaration page and insurance policy. In addition, the Provider has the authority to request and receive any document that have been provided to me and, (2) to endorse in my name any check issued for payment where benefits were assigned. By way of this assignment and notice, I further instruct you, the insurer, to furnish to the Provider copies of all future notices affecting Provider's interest in this claim, including without limitation.

The Provider hereby objects to any reductions or partial payments. Any partial or reduced payment regardless of the accompanying language issued by the insurer and deposited by the Provider shall be done so under protest, at the risk of the insurer, and the deposit shall not be deemed a waiver, accord, satisfaction, discharge, settlement or agreement by the Provider to accept a reduced amount as payment in full.

I further direct my insurer to direct all payments for services rendered by the Provider directly to the Provider at the billing address contained on Provider's repair bills.

THIS IS A DIRECT AND IRREVOCABLE ASSIGNMENT OF MY RIGHTS AND BENEFITS UNDER MY POLICY OF INSURANCE.

A digital copy of this form shall be considered as effective and valid as the original. I have read the foregoing and understand and agree to each of the above provisions.