[contact-form-7 id="2560a63" title="Customer Information"]


Hail Repair Direction for Payment

Email: contact@pdrcrew.com
Austin Phone: (737) 727-2244 
Killeen Phone: (254) 500-3598
Tax Identification Number: 36-48832142

Claim Specialist:

PDR Crew, LLC


Customer Information

First Name:                            Last Name:  

Phone:                                     Email:  

Address:                                 State:  

City (U.S.):                                   ZIP Code:                           Need Rental?:  

Rental

Do you have a secondary car to drive?  

Do you have rental assistance?  

Vehicle

Vehicle Year:                     Vehicle Make:           Vehicle Model:  

Vehicle VIN:                       Vehicle Notes:  

Insurance

Insurance Company:                   Claim Number:  

Policy Number:                               Date of Loss:                                       Deductible Amount:  

Adjuster

Adjuster First Name:                 Adjuster Last Name:  

Adjuster's Email:                           Adjuster's Phone:  


Authorization

I authorize PDR CREW USA LLC to perform the complete repair of my vehicle upon receiving approval from my insurer (AUTHORIZATION FOR REPAIR) and to receive payment directly from my insurer for the repair (DIRECT PAYMENT AUTHORIZATION) by signing this contract. I release PDR CREW USA LLC from any liability for loss or damage to my vehicle. I will maintain full vehicle insurance coverage for bodily injury, property damage, collision, fire, theft, and comprehensive coverage during the repair. I acknowledge that my insurance will cover such damages to the extent that the loss is not caused by PDR CREW USA LLC. I also grant my permission to PDR CREW USA LLC’s employees, agents, contractors, and subcontractors to operate the vehicle for repair, delivery, testing, and inspection purposes.Additionally, I acknowledge that if, upon further inspection, additional repairs are necessary, or (a) such parts are not available in a timely manner, or (b) PDR CREW USA LLC is able to repair the damaged parts through paintless dent removal, conventional repair, or a combination of both, I authorize PDR CREW USA LLC to repair such damaged parts or alternatively use new, used, or replacement parts at its sole discretion. Old parts will be disposed of or recycled appropriately by PDR CREW USA LLC, unless instructed otherwise. I authorize PDR CREW USA LLC to create access to panels that may be inaccessible due to their location in the vehicle. I authorize PDR CREW USA LLC to determine, at its sole discretion, the best repair method for my vehicle (paintless dent removal, conventional repair, replacement, and finishing, or any combination thereof). I further authorize PDR CREW USA LLC, at its sole discretion, to subcontract third parties to repair my vehicle, including, without limitation, one or more shops for conventional care or replacement and finishing work, and to drive my vehicle to and from these third-party facilities.The full amount of repair costs must be paid in full before my vehicle can be released for delivery to me. If my insurance coverage pays all or part of the total amount due, I acknowledge that the insurance check must be sent in advance to PDR CREW USA LLC by the insurer or obtained by me. If my vehicle is deemed a total loss, PDR CREW USA LLC will receive a shop administration/consultation fee of $250 and an internal vehicle storage fee of $200 per day as a settlement for my claim on this vehicle. PDR CREW USA LLC is not responsible for prior damage to the vehicle’s exterior or internal damage to the vehicle occurring after it is returned to me, including, without limitation, damage described in this form. To secure payment for the repair amount, an express mechanic’s lien is acknowledged on my vehicle in favor of PDR CREW USA LLC, and I further agree to pay any reasonable attorney’s fees and court costs if legal action becomes necessary to enforce this contract. If any provisions of this agreement are deemed unenforceable by law, such provisions shall be enforced to the maximum extent permitted by law or otherwise eliminated if necessary, and all other provisions shall remain in full force and effect. If I, the customer, leave my vehicle at the PDR CREW USA LLC shop for repair and, after reviewing the insurance verification, decide not to repair my vehicle, I agree to pay thirty percent of the repair costs approved by my insurer.

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Signature Certificate
Document name: Direction Authorization to Pay
lock iconUnique Document ID: 8a9207cf6edaed72b40cafb4c5a2eb8f24ad5fa2
Timestamp Audit
July 24, 2024 1:55 pm EDTDirection Authorization to Pay Uploaded by Israel Suarez - contact@pdrcrew.com IP 177.184.140.102