Customer / Vehicle Information:

Authorization to release vehicle to 3rd party:

Vincent Service Location:

Terms & Conditions

Important: Please check ONLY the Terms & Conditions that you agree to:

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.

Electronic Signature

Please type your name, sign the form and upload a picture of your driver license or ID

Take a Picture with your phone or upload a picture