Authorization

Complete our online authorization form to get your repair started quickly and conveniently. This form grants us permission to perform the necessary repairs on your vehicle.

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Language / Idioma

Fill out the form below — you'll sign in 4 places

Type directly. The invoice preview below updates as you type. All 4 signatures are required to submit.

Customer Information

Your Details

Full Name *

Phone Number *

Email Address *

Street Address *

City *

State *

Zip Code *

Description of Damage / Vehicle Problem *

Photo of Driver's License *

Click to upload

Vehicle Details

VIN # *

Year *

Make *

Model *

Photo of Vehicle Registration *

Click to upload

Insurance Information (Required if using insurance)

Claim #

Insurance Provider

County Required

After reviewing the information below, please sign the signature fields. To change or correct information, edit the form above.

Please Read Carefully, Check One of the Statements Below, and Sign:

I understand that, under state law, I am entitled to a written estimate if my final bill will exceed $100.

REQUEST A WRITTEN ESTIMATEI DO NOT REQUEST A WRITTEN ESTIMATE AS LONG AS THE REPAIR COSTS DO NOT EXCEED $

THE SHOP MAY NOT EXCEED THIS AMOUNT WITHOUT MY WRITTEN OR ORAL APPROVAL.

I DO NOT REQUEST A WRITTEN ESTIMATE.

Signature

Date:Jun 18, 2026

COMPANY INVOICE

MV:Placeholder

MVR:Placeholder

Address:2760 NW 36th St, Miami, FL 33142

Phone Number:(305) 300-8618

Name:

Address:

City:

State:

Zip:

Phone:

Date:Jun 18, 2026

X INVOICEX ESTIMATE

* U/Used R/Repaired A/Aftermarket S/Straightened

LABOR HOURS

QTY	*	Part	Description	Body	Paint	Frame	Mech
			CUSTOMER COMPLAINT/PROBLEM:
			CLAIM #:

All parts and labor are warrantied for months / miles unless otherwise stated.

Vehicle Information

VIN:

Yr/Make:

Model:

Save Parts:

NoYes

Core may apply

Charges based on:

Hourly RateFlat RateBoth Apply

Estimate Diagnosis:

Fee: $

Hourly at $/hr.

Payment Method:

CashCheckVisaMCAmex

Estimated Cost: $

**This charge represents costs and profits to the motor vehicle repair facility for miscellaneous shop supplies or waste disposal.

***s. 403.718, F.S. mandates a $1.50 fee for each new or manufactured battery sold in the State of Florida.

Estimate good for 30 days. The facility is not responsible for damage caused by theft, fire, or acts of nature. I authorize the above repairs to my vehicle including the necessary materials and sublet work. You and your employees may operate my vehicle for the purpose of testing, inspection, and delivery at my risk. If I cancel repairs to my vehicle for any reason, I understand that a tear-down and reassemble fee of $385 will apply. I understand that a charge of $150 per day will be charged if I fail to pick up my vehicle within (3) working days of notification of completion.

Signature

Date:Jun 18, 2026

Body & Paint	$60.00 / hr	Parts:	$
Structural & Frame	$90.00 / hr	Labor:	$
Mechanical	$135.00 / hr	**Shop Sup:	$
Electrical	$135.00 / hr	Sublet:	$
Paint Materials	$36.00 / hr	***Fees:	$
Inside Storage	$150.00 / day	Subtotal:	$
Outside Storage	$100.00 / day	Tax:	$
Tear-Down & Reassemble	$385.00
Miscellaneous	$	Total:	$

Repair Agreements

Exotic Motors of Florida

VEHICLE REPAIR AUTHORIZATION AND CUSTOMER AGREEMENT

Customer Authorization and Agreement

I, the undersigned, authorize the repair work on my vehicle, as specified, to be performed by Exotic Motors of Florida ("the Repair Shop"). I understand and accept the following terms and conditions regarding the repair and payment of my vehicle.

Care, Custody, and Protection (CCP) Fee

A Care, Custody, and Protection (CCP) Fee will be charged as follows:

$150 per day for vehicles stored inside
$100 per day for vehicles stored outside

These charges begin on the day the vehicle is dropped off at the Repair Shop. In the event that the vehicle is deemed a total loss, this CCP fee will apply from the date of drop-off until the date of removal by the customer or their insurance provider.

Authorization for Parts and Cancellation Terms

I authorize the Repair Shop to order necessary parts for repairs. Should I cancel the repairs after parts have been ordered, I agree to the following:

Restocking Fee: A 30% restocking fee will apply to all parts ordered.
Non-Returnable Parts: If any part ordered is non-returnable due to its status as an electronic or special order, I agree to pay for the part in full, and that part will be provided to me.

Repair Agreement

The Repair Shop is not responsible for loss or damage to my vehicle, or any articles left in the vehicle, due to fire, theft, or any cause beyond its control.
I grant permission to the Repair Shop and its employees to operate my vehicle on streets, highways, or elsewhere as necessary for testing and/or inspection.
An express mechanic's lien is hereby acknowledged on the above-described vehicle to secure payment for all repair work done.
Old Parts: Old parts removed and replaced will be discarded unless otherwise specified by me before repairs begin.

Payment and Insurance Responsibilities

All repair costs, including deductibles and any customer-paid expenses, must be settled in full before the vehicle is released. If my insurance issues a direct payment to me instead of the Repair Shop, I acknowledge that I am solely responsible for paying any outstanding balance.

If repairs are canceled or partially completed, the Repair Shop may charge for teardown costs, parts ordered, and any labor required to reassemble the vehicle.

I have read and agree to the Repair Agreement above, including the Care, Custody & Protection fees, cancellation/restocking terms, parts handling, payment responsibilities, and the estimate & rental policy.

Assignment of Benefits

By my signature below, I hereby assign, transfer and convey to Exotic Motors of Florida (hereinafter "Provider"), all of my rights, title and interest in and to auto repair reimbursement in whatever form, including but not limited to any insurance coverage under property damage, comprehensive, collision, windshield and/or any coverage otherwise payable to me through auto insurance. This payment shall not exceed any indebtedness to the above named assignee and I acknowledge that I will timely pay any indebtedness owed by me to the assignee that is not otherwise satisfied by the above-mentioned assigned proceeds.

I further authorize the Provider to negotiate, collect and settle any claim with any insurance carrier or other third party payor with regard to these services. The Provider has the authority to: (1) request and receive from any insurer documentation and records regarding this claim, and (2) endorse in my name any check issued for payment where benefits were assigned.

The Provider hereby objects to any reductions or partial payments. Any partial or reduced payment shall be deposited under protest, at the risk of the insurer.

THIS IS A DIRECT AND IRREVOCABLE ASSIGNMENT OF MY RIGHTS AND BENEFITS UNDER MY POLICY OF INSURANCE.

A digital copy of this form shall be considered as effective and valid as the original.

Assignment of Benefits Signature

Required — this is a separate legal assignment of your insurance rights.

Date: Jun 18, 2026

E-Sign Consent

Consent to Electronic Communications & Signatures

I authorize Exotic Motors of Florida, Corp, to contact me about my repair via phone, email, or text message and agree to any data rates that may apply. I may opt out of communications at any time.

I agree that this Authorization Form may be executed and delivered by electronic signatures in accordance with the ESIGN Act and UETA. I acknowledge my electronic signature has the same legal force and effect as a handwritten one.

Final Signature

This is your final E-Sign consent.

Sign to complete authorizationDate: Jun 18, 2026