Work Authorization Name First Last Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail Insurance Company Claim # Vehicle Year Vehicle Make Vehicle Model I hereby authorize Stil Swangn LLC to make the specified repairs. I understand that payment in full will be due upon release of the vehicle, including additional supplemental damage charges. I hereby grant Stil Swangn LLC employees' permission to operate the vehicle on the streets, highways, or elsewhere for the purposes of testing and/or inspection. An express mechanics lien is hereby acknowledged on the vehicle to secure the amount of repairs thereto. Stil Swangn LLC will not be held responsible for loss or damage to vehicle or articles left in the vehicle in case of fire, theft, accident or any other cause beyond your control. Old parts removed from the vehicle will be junked unless otherwise instructed. I authorize any/all supplements payable directly to Stil Swangn LLC. I do hereby appoint Stil Swangn LLC to act as Power of Attorney in fact to accept on my behalf any and all check, drafts or bills of exchange, and to endorse all such checks, drafts, bills of exchange for deposit to Stil Swangn LLC's account for credit on my account for repairs to my vehicle which has been released and accepted. I acknowledge that Stil Swangn LLC may identify additional damages parts which were not identified in the initial inspection. I authorize Stil Swangn LLC to make additional repairs without prior notice. In the event I decline to authorize Stil Swangn LLC to repair additional damages identified, I will pay for all parts and labor completed prior to providing said notice. Further, I release, indemnity, and hold harmless Stil Swangn LLC for any claims related to the work performed by Stil Swangn LLC prior to said notice. For your protection, Arizona law requires the following statement to appear on this form. Any person who knowingly presents a false or fraudulent claim for payment of a loss is subject to criminal and civil penalties. VEHICLE RELEASE POLICY All repairs must be paid in full prior to vehicle release unless prior arrangements have been made All deductibles are payable to Stil Swangn LLC Two and three party checks must be endorsed by all parties including lienholders prior to vehicle release. I have read and understand Stil Swangn LLC's Vehicle Release Policy _____________. I understand that estimated delivery date is not guaranteed and is subject to change Vehicles not picked up within 5 days of completion will be charged a $250 per day storage fee. Name First Last PhoneDate MM slash DD slash YYYY By Clicking Submit I am digitally signing this form and giving authorization and power of attorney to Stil Swangn LLC. as set forth in this document