Forms

 
DTP - only needs to be signed in the direct to pay box only
 
Repair Authorization - Needs to be completed in full
 
Customer contact sheet - needs to be filled out below "I would like to be contacted" the RO and completion date is filled in after we receive
 
DTP - only needs to be signed in the direct to pay box only

DIRECTION TO PAY / COMPLETED WORK CLAIM FORM

 
Company:
 
 
You are required by Massachusetts law (Chapter 90, Section 340) to complete this form before we will pay for repairs to your auto under the Collision, Limited Collision and Comprehensive Coverage (Parts 7, 8 and 9) in your Massachusetts Automobile Insurance policy
 
DATE
 
Policy Holder
 
date of loss
 
file number
 
 
 
premuim payments are
 
Return to
 
 
 
Reinspected on:
 
 
 
Reinspected by:
 
 
 
 
current:
 
 
 
Not Current:
 
 
 
 
SECTION 1 IF YOU HAVE YOUR AUTO REPAIRED
Your policy allows us to make an appraisal of your damages before repairs. If you then have the auto repaired in accordance with our appraisal, you must sign this form, have your repair shop certify the information at the bottom of the page, and send to us. We must pay your claim, subject to deductible, within seven (7)days after we receive the properly signed and certified form. We have the right to inspect the repairs.
 
Statement of repair
All the damage to my auto has been repaired in accordance with the appraisal. The repairs were completed by:

AMERICAN AUTO BODY AND REPAIR INC. * 20 MOORE ST. * LEOMINSTER, MASSACHUSETTS 01453
 
XXXXXXXXXXXXXXXXXXXXX
signature of the policy holder
 
XXXXXXXX
date
 
 
* direction to pay *
We will either pay you or if you request, we will pay the repair shop directly. If you wish us to pay the repair shop directly, please sign below.
 
signature of the policy holder
 
date
 
SECTION 2 IF YOU DO NOT HAVE YOUR AUTO REPAIRED
If you choose not to have your auto repaired, or if we do not receive this for, we will determine the amount of the decrease in the actual cash value of your auto and pay you that amount less your deductible. We will never pay more than what it would cost to repair the damage. Our payment automatically reduces the actual cash value of your auto in case of further claims. If you later give us proof proper repair, the actual cash value will be increased. If you choose not to have your auto repaired, please sign below.
 
 
Garage Liability Policy: CNA. 0118174178
Federal ID# 042618081
Mass RE# 470 EXPIRATION DATE: 5/31/17
 
Licensed Appraiser: Dennis A. Rosa # 006354
Sales Tax# 95879
Hazardous Waste# MAD075351726
 
 
 
Repair Authorization - Needs to be completed in full
AMERICAN AUTO BODY AND REPAIR, INC
20 MOORE ST.
LEOMINSTER, MASSACHUSETTS 01453
TELEPHONE: (978) 537-7042
FAX: (978) 840-4492
REPAIR AUTHORIZATION
FOR THE WRITTEN ESTIMATE FOR PARTS AND LABOR
INCLUDING ANY SUBSEQUENT SUPPLEMENTAL DAMAGE
PLEASE NOTE: Once we have an estimate for repairs we will be able to let you know the approximate number of days your vehicle will be in the shop for repairs. If additional damage is found once the repair process begins, the repairs may take longer than anticipated. We strive to maintain the time frame quoted for the repairs, however, occasionally there are circumstances beyond our control which may delay the process.We do a minor detailing on most vehicles when repairs are completed, therefore in order to expedite the repair and detailing process we ask that you please take the majority of miscellaneous items and especially any valuable items out of your vehicle prior to the repair appointment. Please be sure to remove items from the trunk if work is required to the rear of your vehicle, including bumper work..
 
I,
 
(PLEASE PRINT)
 
give American Auto Body and Repair, Inc.
permission to repair my
VEHICLE DESCRIPTION
 
 
SIGNED:
 
 
 
 
date:
 
 
 
 
 
Customer contact sheet - needs to be filled out below "I would like to be contacted" the RO and completion date is filled in after we receive
REPAIR UPDATE COMMUNICATION
Dear Valued Customer,

In order to best serve your needs, please let us know how frequently you would like to be updated by the repair facility on the status of your vehicle throughout the repair process.
 
 
Shop RO #:
 
 
 
 
Estimated Completion Date:
 
 
 
* Check the applicable box for repair updates & communication preference:
* I would like to be updated on the repairs to my vehicle:
 
 
 
 
 
 
* My preferred contact method is:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Please take a moment to tell us what your main concerns are regarding the repairs to your vehicle so that we can better ensure your satisfaction (for example: anything you may have noticed since the accident was reported, any pulling to left or right, doors not opening or closing properly, etc.):
 
 
Customer Signature:
 
 
 
 
date: