Submit Your Information by Filling the Form or Uploading Documents

Please choose one of the options below to submit your information. You can either fill out the form directly or upload your documents (Registration and Insurance Certificate).

 

Add your copy or pic registration Plus second copy of your Insurance certificate :-

 

Upload Registartion (copy or pic )
Click or drag a file to this area to upload.
Upload Insurance Certificate (copy or pic)
Click or drag a file to this area to upload.

Authorization to Repair and Direction of Payment

I hereby authorize The LABS Collision Center to disassemble my/our vehicle for the purpose of damage
inspection and/or to make all necessary repairs.

You and your employees may operate my/our vehicle for the purpose of testing, repairs, inspections, and delivery
at my/our risk.

I further authorize and direct my Insurance company and/or any responsible party to pay Insurance proceeds
directly to The LABS Collision Center for repairs performed.

Insurance Company Name :

Insurance Company Claim Number:

Vehicle Owner Name:

Vehicle (Year / Make / Model):

VIN / Serial Number:

Vehicle Owner Authorization

Date :

Printed Name:

Signature :

Click or drag a file to this area to upload.

Certificate of Satisfaction

Repairs have been completed to my/our satisfaction

Owner Signature:

Click or drag a file to this area to upload.

Date: