State Farm

AUTHORIZATION AND DIRECTION TO PAY

Vehicle description:

I authorize (d) Buckhead Collision to estimate and repair my vehicle, unless it is an economic total loss

By Checking this box you agree to the Terms & Conditions

I have received a copy of the initial and final automated repair estimate.

I authorize Buckhead Collision to be paid on my behalf $

By Checking this box you agree to the Terms & Conditions

I certify that repairs have been completed as indicated on the final automated repair estimate.

Signature

Date

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