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.
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.
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When filling out the Authorization And Direction Pay form, keep these key points in mind:
Following these steps will help ensure a smooth experience with your insurance claim and repair process.
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 _________________________________________________________________________________________________