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Green Chevrolet Chrysler

1703 Avenue Of The Cities
East Moline, IL 61244

  • Sales: (888) 818-3357
  • Service: (866) 980-9852
  • Parts: (888) 681-2115

Collision Repair Form

Green Chevrolet Chrysler Collision

Repair Authorization Form


In agreement with the mobile estimating services provided. You are hereby authorized to make repairs to the below mentioned vehicle. I understand that the estimator from Green Chrysler Collision Center will work with and come to and agreed cost of repair with the insurance company paying for repairs.
By signing this authorization I give permission for Green Chevrolet Chrysler to act as a power of attorney to sign any insurance checks for the damages to my vehicle as a result of this claim.

Once the agreed cost of repairs has been established with the liable insurance company and parts are ordered I understand that there is a standard 30% restocking fee for any cancellation that results in having to return the parts that I authorized.


Date ______________________

Signed ______________________________

Printed Name _____________________________

Vehicle year ________________ Make ____________________ Model____________________

Vin # _______________________________________________




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