Authorization Form

"*" indicates required fields

Repair Authorization And Direction To Pay

Name*

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Vehicle Year/Make/Model*

Date of Loss

Insurance Carrier*

Please Indicate Which Applies to You

Are you the Registered Owner?

Do you have the Original Insurance Check?

Communication*

Email*

Phone*

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*

First Last

Signature

Date

CAPTCHA

Three Locations to Choose From

13148 W. Foxfire Dr 113 Surprise, AZ 85378

Open 8am to 5:30pm Mon – Fri and 8am to noon on Sat.

Phone: (623) 915-2886

Email: alfonso@chaneyscollision.com

SCHEDULE AN APPOINTMENT IN SURPRISE

SCHEDULE AN APPOINTMENT IN GLENDALE

7161 N 61st Ave, Glendale, AZ 85301

Open 8am to 5pm mon – fri and 8am to noon on sat.

Phone: (623) 934-9000

Email: francisco@chaneyscollision.com

7910 N. Glen Harbor Blvd. Glendale, AZ. 85307

Open 8am to 5:30pm Mon – Fri and 8am to noon on Sat.

Phone: (623)248-8119

Email: chris@chaneyscollision.com

Looking for a collision repair facility you can trust?
Look no further!

Authorization Form

Repair Authorization And Direction To Pay

Authorization To Repair

Rental Car Notice

One Time Endorsement And Refund Notice

Assignment Of Rights And Direction To Pay Motor Vehicle Claim

Three Locations to Choose From

SCHEDULE AN APPOINTMENT IN SURPRISE

SCHEDULE AN APPOINTMENT IN GLENDALE

SCHEDULE AN APPOINTMENT IN GLEN HARBOR

Looking for a collision repair facility you can trust? Look no further!

Authorization Form

Repair Authorization And Direction To Pay

Authorization To Repair

Rental Car Notice

One Time Endorsement And Refund Notice

Assignment Of Rights And Direction To Pay Motor Vehicle Claim

Three Locations to Choose From

SCHEDULE AN APPOINTMENT IN SURPRISE

SCHEDULE AN APPOINTMENT IN GLENDALE

SCHEDULE AN APPOINTMENT IN GLEN HARBOR

Looking for a collision repair facility you can trust?
Look no further!