Work authorization

Work Authorization

* (Required Fields)
Contact Information
Owner/Agent First Name*

Please type Owner/Agent first name

Owner/Agent Last Name*

Please type Owner/Agent Last Name

Email*

Please type E-Mail Id

Primary Phone*

>Please type Phone No.

Address*

Please type E-Mail Id

State*
city*

Please type City name

Zip Code*

Please type Zip Code.

Survey Question
Vehicle Year*

Please type Vehicle Year

Vehicle Make*

Please type Vehicle Make

Vehicle Model*

Please type Vehicle Model

Vehicle License Plate*

Please type Vehicle Model

Insurance Company*

Please type Insurance Company

Agent*

Please type Insurance Company



Legal*

Owner/Agent acknowlwdges payment in the from of Cash,Cashier's Check,Debt,Visa,Master Card,or Discover.No other forms of payment will be accepted.

Owner/Agent warrants & represents that WestSide Chevrolet isnt responsible for window tint or glass breakeage/damage due to removal or work being performed

Owner/Agent acknowledges and understand that payment of insurance deductible is due to Westside Chevrolet Inc.prior to release of the vehicle

Owner/Agent acknowledges and understands that all vehicles left over ten(10) days after scheduled pic -up date will incure a @10.00 per day storage fee.

Owner/Agent acknowledges and understands that all work left over thirty(30) days will be subject to foreclosure of Westside Chevrolet lien.


By clicking Submit Owner/Agent agrees to...

I warrant and represent that I am the owner of the above described vehicle (hereinafter “the vehicle”) or an authorized agent of the owner andthat Westside Chevrolet is authorized to repair the vehicle and provide the necessary services, part, and materials needed for the repair. I further authorize Westside Chevrolet employees to operate the vehicle on streets and elsewhere for the purpose of testing and/or inspection. I acknowledge and understand that Westside Chevrolet will have an express mechanics lien on and a security interest in the vehicle until such time as all indebtedness is paid in full. I further agree that Westside Chevrolet. shall not be responsible for loss or damage to articles left in the vehicle in case of fire, theft or any other cause. I further authorize Westside Chevrolet to be my representative to negotiate with any insurance company/representative regarding the restoration of the vehicle to pre-accident condition and value. Westside Chevrolet is authorized to endorse drafts from insurance company securing payment. Notice Pursuant to Texas Property Code 70.001.

I warrant and represent that I am the owner of the above described vehicle or an authorized agent of the owner. I acknowledge and understand that Westside Chevrolet will have an express mechanics lien on and a security interest in the vehicle until such time as all indebtedness is paid in full. I further acknowledge and understand that: (1) if the vehicle is released by Westside Chevrolet the vehicle remains subject to Westside Chevrolet mechanics lien and/or security interest until such time as all indebtedness is paid in full; and (2) Westside Chevrolet has the right to repossess and sell the vehicle in satisfaction of its lien or security interest if; (a) the indebtedness remains unpaid for 30 or more days; or (b) any check, draft, or negotiable instrument is dishonored for any reason; or (c) the drawer or maker of the order has no account or the account on which it is drawn has been closed.

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