Select Insurance Company
Texas Farm Bureau
Received First Insurance Check?
Number of people in vehicle at the time of accident?
Clicking the boxes indicates you have read and agree to the following statement(s):
Optimum Collision Ennis is not responsible for loss or damage to vehicles, articles, or personal property left in vehicles, in case of fire,theft, natural disasters or any other cause beyond our control. Please remove all personal belongings from your vehicle.
No car will be released until full payment is made.Deductible and insurance check or proof of loss must be received before vehicle will be released. Be certain all payee's(including lien holders) have endorsed the insurance check prior to completion of repairs.
The maximum payment using a credit or debit card shall not exceed $3000.00 Vehicles that have sustained extensive damage could require more time to repair and exceed your rental coverage. Optimum Collision Ennis will not be responsible for any rental expense in the event this occurs. NOTICE PURSUANT TO SECTION 70.001, TEXAS PROPERTY CODE Customer understands that this vehicle is subject to repossession in accordance with Section 9.609, Texas Business & Commerce Code, if a written order of payment for repairs of the vehicle is stopped, or dishonored because of insufficient funds, no funds, or because the drawer or maker of the order has no account or the account on which it is drawn has been closed. I have read and agree to the Terms and Conditions.
Known all men by these presents; that I (or we) the undersigned , do hereby and constitute and appoint Optimum Collision Ennis as my (or our) true and lawful agent and attorney-in-fact to endorse in name, place and stead of the undersigned and check or draft issued by above insurance company to cover all or part of repairs to my (or our) vehicle which are authorized by me (or us) in what ever manner is necessary to negotiate such check or draft for the purpose of paying for such repairs. I (or we) hereby ratify and confirm whatever action said agent and attorney in fact my take in such regard by virtue hereof. I authorize Optimum Collision Ennis to complete estimated repair work to be done along with the necessary materials. And hereby grant you,and/or your employees permission to operate the vehicle herein described on streets, highways or elsewhere for the purpose of completing repairs, testing and/or inspection.An express mechanic's lien is hereby acknowledged on above vechile to secure the amount of repairs thereto.
Authorization to Access Vehicle Data: I understand that modern vehicles are complex and that electronic data recorded in vehicle systems may help to diagnose necessary repairs and to confirm that applicable systems are functional after repairs are performed. I authorize Optimum Collision Ennis to access this data as part of the diagnostic and repair process.
In the event of the the insurance company processing repairs reject payment for repair scans and necessary calibrations to your vehicle as per manufacturer guidelines, these repair scans and calibrations are required and will be paid by the vehicle owner.