Vehicle Repair Agreement
Direction of Pay Authorization
Eastern Auto Works
2940 Old Route 50 · Cambridge, MD 21613
Phone: 443-521-9655 / Fax: 443-225-6584
Customer Information
- Customer Name
- Phone
Vehicle Information
- Year/Make/Model
- VIN
- Submitted
Agreement Terms
I, the "Customer," authorize Eastern Auto Works, my selected repair facility, to conduct repairs on the vehicle listed above and permit its employees to operate the vehicle as necessary during the repair process. I agree to remove all personal belongings from the vehicle prior to repairs and will not hold Eastern Auto Works liable for loss or damage to any items left inside. Should repairs be paused or canceled before completion, fees for storage, administrative efforts, bay occupancy, and other related costs may be charged from the date the vehicle arrived until all dues are paid and the vehicle and its components are removed from Eastern Auto Works.
I direct that payment from my insurance company, or any other source, be made directly to Eastern Auto Works for all repairs performed on the above-listed vehicle. Eastern Auto Works will collaborate with my insurance provider to maximize coverage; however, I acknowledge that the repair costs may exceed what the insurance company agrees to pay. This could result from factors including, but not limited to, labor rates, material costs, parts pricing, manufacturer repair guidelines, pre-existing damage, denied procedures, or disagreements on repair time. Should the insurance provider refuse to cover any portion of the repairs, I accept responsibility for the difference in cost upon completion, and I understand and acknowledge that the vehicle will not be released until paid in full.
I understand that Eastern Auto Works will not compromise the safety, quality, or value of my vehicle by negotiating with insurance providers over these matters. I acknowledge that the vehicle will not be released until full payment is received or final proof of payment from the insurance company is provided.
I acknowledge that in the event of a dispute regarding the release of my vehicle, Eastern Auto Works may require a court order for replevin to facilitate the return of the vehicle or its components, and I agree to abide by the legal process as determined by applicable law.
Customer Signature
Date Signed:
Electronic Signature Acknowledgment: By signing above and typing their name, the customer acknowledged that this electronic signature is legally binding and has the same legal effect as a handwritten signature.