Online Authorization

Complete the form below to submit vehicle and authorization information to Vincent Service. Required fields are marked with an asterisk.

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1. Customer & Vehicle Information

State *

Customer Name *

Customer Email *

Customer Phone *

Vehicle Year / Make / Model *

License Plate # *

Invoice No. *

2. Authorization to Release Vehicle to Third Party

Authorized Person's Name *

Phone *

Address *

3. Vincent Service Location

Select Location *

4. Terms & Conditions

Please check only the terms and conditions that you agree to. Items marked Required must be accepted before the form can be submitted.

I authorize Vincent Service Inc. to disassemble my car for the purpose of preparing a full estimate of the cost of repair. A written estimate delivered via email using the email address I've included above is acceptable to me.

Authorization to Access Vehicle Data: I understand that modern vehicles are complex and that electronic data recorded in vehicle systems may help to diagnose necessary repairs and to confirm that applicable systems are functional after repairs are performed. I authorize Vincent Service Inc. to access this data as part of the diagnostic and repair process and to include this data in compilations that may be used to study the causes of accidents or to achieve improvements in repair processes.

I authorize my insurance to make payment directly to Vincent Service Inc. to endorse and deposit my insurance company check or draft.

I authorize my insurance company to move my vehicle to a Auto Body of my choice listed above.

5. Electronic Signature

Type your name, upload a photo of your driver's license or ID, and sign below.

Your Name *

Driver's License or ID Photo *

You can take a picture from your phone or upload an existing image.

Signature *