Free Authorization And Direction Pay PDF Form Get Document

Free Authorization And Direction Pay PDF Form

The Authorization And Direction Pay form is a crucial document that allows a policyholder to direct their insurance company to pay a specific repair facility directly for a claim. This form streamlines the payment process, ensuring that the repair shop receives the funds needed to complete the necessary work. To get started, please fill out the form by clicking the button below.

Get Document
Outline

The Authorization and Direction Pay form serves as a crucial document in the claims process, facilitating the direct payment from an insurance company to a repair facility. This form is essential for ensuring that the financial transaction is handled smoothly and efficiently, minimizing delays in the repair of a vehicle following an accident. It requires the claimant to provide key information, including their name, address, and contact details, as well as specifics about the vehicle, such as the license plate number, make, model, and year. Furthermore, the form necessitates the inclusion of the insurance company's name and claim number, which are vital for processing the payment accurately. By signing this document, the claimant authorizes the insurance company to issue payment directly to the chosen repair facility, thereby streamlining the process. The form also includes a stipulation that if a settlement check is mistakenly sent to the claimant, they must promptly notify the repair shop and deliver the check within 24 hours. This provision underscores the importance of communication and cooperation between all parties involved, ensuring that repairs can commence without unnecessary financial complications.

Key takeaways

When filling out the Authorization And Direction Pay form, keep these key points in mind:

  • Complete Information: Ensure all required fields are filled out accurately. This includes your name, address, and the details of your vehicle.
  • Insurance Details: Clearly state the name of your insurance company and the claim number. This helps avoid any confusion during the payment process.
  • Direct Payment Authorization: You must authorize your insurance company to pay the body shop directly. Specify the amount to be paid to ensure the body shop receives the correct funds.
  • Prompt Notification: If you receive a check by mistake, notify the repair facility immediately and deliver the check within 24 hours. This keeps everything on track and avoids delays.
  • Sign and Date: Don’t forget to sign and date the form. Your signature confirms your agreement and authorization for the payment process.

Following these steps will help ensure a smooth experience with your insurance claim and repair process.

Form Preview Example

DIRECTION TO PAY FORM

OWNER/CLAIM INFORMATION

Name _________________________________________________________________ License Plate ______________________________

Address ___________________________________________________________________________________________________________

Home Phone _________________________________________

Business/Cellphone __________________________________________

Year _____________________ Make _____________________

Model _ _____________________________________________________

Insurance Company ___________________________________

Claim # _____________________________________________________

DIRECTION TO PAY

I authorize ____________________________________________ Insurance Company to pay ____________________________________

directly on claim number ________________________________ in the amount of $___________________. In the event the insurance

or adjustment company inadvertently mails the settlement/supplement check to me in error, I hereby agree to notify the repair facility immediately and deliver the check to that facility within 24 hours of my receipt of said check.

Customer Printed Name

Customer Signature

Date

Body Shop _________________________________________________________________________________________________________

Body Shop Tax ID ___________________________________________________________________________________________________

Body Shop Address _________________________________________________________________________________________________

Body Shop Phone __________________________________________________________________________________________________

Body Shop Contact _________________________________________________________________________________________________