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?
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Authorization to Repair

Rental Car Notice

Please select one of the below required fields.

One Time Endorsement and Refund Notice

Assignment of Rights and Direction to Pay Motor Vehicle Claim

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

Council Bluffs Iowa

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

Body Shop 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 – West

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

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

Omaha (Leavenworth) Nebraska

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

Omaha (Grover) Nebraska

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

Omaha (H&H) Nebraska

10801 S 150th St
Papillion, NE 68138
(402) 609-4009

Omaha (Onyx) Nebraska

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

Omaha (Emmet) Nebraska

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

Payson Arizona

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

Phoenix Arizona Deer Valley

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