Authorization

Complete our online authorization form to get your repair started quickly and conveniently. This form grants us permission to perform the necessary repairs on your vehicle.

Have questions? We're here to help!

Call Now: (620) 225-2213

VEHICLE REPAIR AUTHORIZATION

Legally Binding Repair Authorization and Consent

John’s Body ShopDodge City, KS

IMPORTANT NOTICE:

This is a legally binding document. By signing, you authorize John’s Body Shop, Inc. ("John’s Body Shop") to perform repair work on your vehicle under the terms described below, pursuant to Kansas Statutes Section 58-201 (Mechanic's Lien).

1Customer Information
2Vehicle Information
3REPAIR AUTHORIZATION AGREEMENT

1. AUTHORIZATION FOR REPAIRS

This document is a legally binding agreement between John’s Body Shop, Inc. ("the Shop") and the undersigned customer. I authorize the Shop to perform all required repair work on my vehicle, including necessary materials and any additional damage discovered during the disassembly or repair process ("Supplemental Repairs"). I grant the Shop and its employees permission to operate my vehicle on streets, highways, or elsewhere as necessary for testing, inspection, and delivery, at my risk. I understand and agree that I am ultimately responsible for the full repair cost, regardless of insurance coverage.

2. CARE, CUSTODY & PROTECTION (STORAGE) FEE

Storage charges will accrue beginning 3 calendar days after the Shop notifies me that repairs are complete. If an insurance estimate is absent or unresolved within 10 business days, storage charges begin from the date the vehicle arrived at the Shop. If the vehicle is deemed a total loss, the storage fee applies until the date of removal by the customer or their insurance provider.

  • Inside storage: $150/day
  • Outside storage: $125/day

3. PARTS AUTHORIZATION & CANCELLATION TERMS

I authorize the Shop to order the parts necessary 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 item, I agree to pay for that part in full, and it will be provided to me.
  • If repairs are canceled or partially completed, the Shop may charge for teardown costs, parts ordered, and any labor required to reassemble the vehicle.
  • If the vehicle is deemed a total loss, or is towed/driven in and then moved to another facility for any reason, I may be charged administrative fees, debris-cleanup charges, estimate/teardown fees, and storage from the date of arrival.

4. PAYMENT & INSURANCE RESPONSIBILITY

Payment is due in full before the vehicle is released. Accepted payment methods are cash, certified check, credit/debit card, or a properly endorsed insurance draft. If my insurance issues a direct payment to me instead of the Shop, I acknowledge that I am solely responsible for paying any outstanding balance. My repair bill may differ from my insurance company's estimate; labor is billed using industry-standard flat-rate time units.

  • My insurance deductible
  • Any charges not covered by insurance (betterment, depreciation, upgrades)
  • All Supplemental Repairs I authorize

5. REPAIR TIMELINE & RENTAL POLICY

The Shop makes no guarantee regarding repair completion times due to possible delays from insurance approvals, parts availability, or other factors beyond our control. Rental or alternative transportation coverage, if required, is my responsibility and may not be reimbursed by the Shop.

6. LIABILITY LIMITATIONS

The Shop is NOT responsible for the following. Old parts removed and replaced will be discarded unless I request their return in writing before repairs begin. PLEASE REMOVE ALL PERSONAL ITEMS FROM YOUR VEHICLE.

  • Loss or damage to the vehicle or any articles left in it due to fire, theft, or any cause beyond the Shop's control
  • Personal items left in the vehicle (electronics, valuables, tools, clothing, etc.)
  • Delays caused by parts unavailability, insurance, or other factors beyond the Shop's control
  • Pre-existing damage not related to the current repairs
  • Loss of use, rental costs, or any consequential or incidental damages

7. MECHANIC'S LIEN (Kansas Statutes Section 58-201 (Mechanic's Lien))

An express mechanic's lien is hereby granted on the above-described vehicle to secure payment for all labor, parts, storage, and charges, pursuant to Kansas Statutes Section 58-201 (Mechanic's Lien). No vehicle will be released until all charges are paid in full. Failure to make payment within 20 days of notification of completion will result in the commencement of the lien enforcement process per Kansas Statutes Section 58-201.

  • Retain my vehicle until paid in full
  • Enforce the lien through sale per Kansas law if unpaid

9. ELECTRONIC COMMUNICATIONS & SIGNATURES

I authorize the Shop to contact me about my repair via phone (including autodialed calls), text/SMS, and email, and I agree to any data rates that may apply. I may opt out at any time by replying STOP to a text message or using the unsubscribe link in an email. This Authorization Form may be executed and delivered by electronic signature in accordance with the ESIGN Act and UETA; my electronic signature has the same force and effect and is the legal equivalent of my manual signature.

10. DISPUTE RESOLUTION & GOVERNING LAW

Any dispute will first be addressed through good-faith negotiation between the parties. This agreement is governed by the laws of the State of Kansas, and any legal action must be brought exclusively in the courts of Ford County, Kansas.

4DIRECTION TO PAY

8. DIRECTION TO PAY & ASSIGNMENT OF BENEFITS

I authorize and direct payment to the Shop and its affiliated companies, and I assign all insurance proceeds for this claim to the Shop up to the full invoice amount. By my signature below, for good and valuable consideration (including the extension of credit to me), I assign, transfer, and convey to the Shop all of my rights, title, and interest in and to auto repair reimbursement in any form, including coverage under property damage, comprehensive, collision, windshield, and/or any coverage otherwise payable to me. This payment shall not exceed my indebtedness to the Shop, and I will timely pay any remaining balance not satisfied by the assigned proceeds. I further authorize the Shop to negotiate, collect, and settle any claim with any insurer or third-party payor, including to:

  • Request and receive from any insurer all documentation and records regarding this claim (statement of coverage, declarations page, and policy)
  • Endorse in my name any check issued for payment where benefits were assigned
  • Deposit any reduced or partial payment under protest — the Shop objects to all reductions, and any such deposit is not a waiver, accord, or satisfaction
  • Direct my insurer to pay the Shop directly at the billing address on the Shop's repair bills

THIS IS A DIRECT AND IRREVOCABLE ASSIGNMENT OF MY RIGHTS AND BENEFITS UNDER MY POLICY OF INSURANCE. A photocopy or digital version of this form is as valid and effective as the original.

CUSTOMER ACKNOWLEDGMENT

By signing below, I confirm:

  • 1. I have read and understand all terms
  • 2. I am responsible for full payment regardless of insurance
  • 3. I have removed all personal items from my vehicle
  • 4. I understand the Shop's lien rights and storage charges
  • 5. I authorize repairs and accept pricing may differ from the insurance estimate
  • 6. I received a copy of this agreement

IMPORTANT: This is your legal authorization to repair. Keep a copy for your records.

5FINAL ACKNOWLEDGMENT
Secure & Confidential — 256-bit encrypted
Legally Binding — ESIGN Act compliant