Authorization Form

Authorization form and direction to pay

Repair Authorization and Direction to Pay

"*" indicates required fields

Name*
Address
MM slash DD slash YYYY
Are you the Registered Owner?
Do you have the Original Insurance Check?
Communication*
This is my preference for automated messages

Authorization to Repair

Consent*
Consent*
Consent*
Consent*
Consent*
Consent*
Consent*
Consent*
Consent*
Consent*
Consent*

Rental Car Notice

Please select one of the below required fields.
Consent
Consent (Rental Car Needed)

One Time Endorsement and Refund Notice

Consent*

Assignment of Rights and Direction to Pay Motor Vehicle Claim

Consent*
Owner/Assignor(s) Name*
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.

Find Your Location

Anaheim California

3421 E La Palma Ave
Anaheim, CA 92806
(714) 630-3322

Arvada Colorado

5855 W 56th Ave
Arvada, CO 80002
(303) 424-6091

Aurora Colorado

92 S Havana St
Aurora, CO 80012
(303) 366-4134

Brighton Colorado

109 W Walnut St
Brighton, CO 80601
(303) 654-1191

Camp Verde Arizona

1900 North Moonrise Drive
Camp Verde, AZ 86322
(928) 567-7270

Commerce City Colorado

7350 Highway 2
Commerce City, CO 80022
(303) 289-3458

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1328 35th Ave
Council Bluffs, IA 51501
(712) 256-8100

Delta Colorado

60 Tuscher St
Delta, CO 81416
(970) 874-8474

Flagstaff Arizona (East)

2360 E Huntington Dr
Flagstaff, AZ 86004
(928) 226-1100

East Northglenn Colorado

10555 Irma Dr
Northglenn, CO 80233
(720) 541-7697

El Mirage Arizona

8030 N El Mirage Rd
El Mirage, AZ 85335
(623) 935-6678

Fort Collins Colorado

4221 S Mason St
Fort Collins, CO 80525
(970) 305-8628

Fort Lupton Colorado

540 Main St
Fort Lupton, CO 80621
(303) 502-3392

Frederick Colorado

8478 Raspberry Way
Frederick, CO 80504
(303) 485-8840

Fullerton California

700 Williamson Ave
Fullerton, CA 92832
(714) 515-5157

Gilbert Arizona

250 N Pasadena St
Gilbert, AZ 85233
(480) 545-0870

Glendale Arizona

4825 W Glendale Ave
Glendale, AZ 85301
(623) 930-9795

Golden Colorado

446 Orchard St
Golden, CO 80401
(303) 279-4223

Grand Junction Colorado

552 25 Rd
Grand Junction, CO 81505
(970) 243-2834

Greeley Colorado

2908 W 10th St
Greeley, CO 80634
(970) 800-4563

Gunnison Colorado

702 South 9th Street
Gunnison, CO 81230
(970) 641-5510

Las Vegas Nevada

3595 Boulder Hwy
Las Vegas, NV 89121
(702) 457-3002

Las Vegas Nevada

4542 W Hacienda Ave
Las Vegas, NV 89118
(702) 362-9500

Lemon Grove California

3580 Olive St
Lemon Grove, CA 91945
(619) 460-1365

Loveland Colorado

401 S Lincoln Ave
Loveland, CO 80537
(970) 663-6378

Mesa Arizona

5045 East McKellips Road
Mesa, AZ 85215
(480) 325-5035

Omaha (Midtown) Nebraska

4103 Leavenworth St
Omaha, NE 68105
(402) 551-6000

Omaha Nebraska

14540 Grover St
Omaha, NE 68144
(402) 334-7100

Omaha Nebraska

4645 S 84th St
Omaha, NE 68127
(402) 609-4009

Omaha Nebraska

14800 Davenport St
Omaha, NE 68154
(402) 255-3403

Omaha Nebraska

10921 Emmet St
Omaha, NE 68164
(402) 933-9600

Payson Arizona

201 N Tonto St
Payson, AZ 85541
(928) 468-8121

Phoenix Arizona

1920 W Deer Valley Rd
Phoenix, AZ 85027
(623) 582-2787

Salida Colorado

716 Park Ave
Salida, CO 81201
(719) 539-7359

San Diego California

2111 Morena Blvd
San Diego, CA 92110
(619) 900-7650

Scottsdale Arizona

8175 E Raintree Dr ste 6
Scottsdale, AZ 85260
(480) 361-4974

Sedona Arizona

2245 Shelby Dr
Sedona, AZ 86336
(928) 282-1635

Flagstaff Arizona (West)

1186 W University Ave # 1
Flagstaff, AZ 86001
(928) 226-1200

Tempe Arizona

622 S Hacienda Dr
Tempe, AZ 85281
(480) 968-5915

West Northglenn Colorado

535 W 115th Ave
Northglenn, CO 80234
(303) 450-0108

Yuma Arizona

3325 South Bonanza Avenue
Yuma, AZ 85365
(928) 726-6030