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Work Authorization

Owner/Agent Name (required): Referred By (required):
   
   
Address(required):
 
 
City (required):
State (required): Zip (required):
 
   
   
Contact Information
Day Phone (required):
Cell :
 
   
Email(required):
 
   
Preferred Method of Contact (check all that apply):  
 
   
Vehicle Information
   
Vehicle Make(required): Model(required):
Color(required): Year(required):
   
   
   
Insurance Company (required): Referring Agent (required):
   
   
Claim Number:  
 
I warrant and represent that i am the owner of the above described vehicle (hereinafter "the vehicle") or an authorized agent of the owner and that
Westheimer Paint & Body. is authorized to repair the vehicle and provide the necessary services, part, and meterials needed for the repair. i further
authorize Westheimer Paint & Body. employees to operate the vehicle on streets and else where for the purpose of testing and/or inspection. I
acknowledge and understand that Westheimer Paint & Body. will have an express mechanics line on and a security interest in the vehicle until such time
as all indebtedness is paid in full. I further agree that Westheimer Paint & Body. shall not be responsible for loss or damage to articles left in the
vehicle in case of fire, theft or any other cause, I further authorize Westheimer Paint & Body. to be my representaive to negotiate with any insurance 
company/representative regarding the restoration of the vechile to pre-accident condition and value. Westheimer Paint & Body. is authorize to endors
drafts from insurance company securing payment.
 
 
Signature (required):
   
   
Notice Pursuant Texas Property 70.001
   
I warrant and represent that i am the owner of the above described vehicle or an authorized agent of the owner. I acknowledge and understand that
Westheimer Paint & Body. will have an express mechanics lien on and a security interest in the vehicle until such time as all indebtedness is paid in
(1) If the vehicle is released by Westheimer Paint & Body. the vehicle remains subject to Westheimer Paint & Body. Mechanics Lien and or security
interest until such time as all indebtedness is paid in full and
(2) Westheimer Paint & Body. has the right to repossess and sell the vehicle in satisfication of its lien or security interest if :
       (a) The indebtendess remains unpaid for 30 or more days or
       (b) Any check, draft or negotiable instrument is dishonored for any reason or 
       (c) The drawer or marker of the order has no account or the account on which it is drawn has been closed. 
 
Signature (required):
 
 
 


Rental Cars
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We deal with all Insurance Companies

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Contact

Tel : +1 281-679-8977
Fax : +1 281-679-8927

Working Hours :
M-F 8:00AM-6:00PM
Sat 8:00AM-1:00PM
Sun Closed

Email :
westheimerpaintandbody@yahoo.com

WebSite :
bodyshopwestheimer.com

Address :
2525 Westhollow Dr.
Houston, Tx 77082