Drop Off Form Brown Collision Center Customer Contact Information:Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Phone*Email* Preferred contact method?* Call Text Email Vehicle InformationColor* License Plate* Year* Manufacturer* Model* Insurance Information (if applicable)Company Name Claim # Select One Insured Claimant Deductible AmountRENTAL VEHICLES – Brown Collision Center cannot be responsible for any rental reimbursement that occurs as a result of delays in repair nor are we responsible to provide a rental vehicle if the repairs are not completed before your rental coverage expires. Collision repair may contain hidden variables during the repair process that may delay your vehicle from being completed by the original estimate delivery date. Our responsibility is to provide you with a quality repair relative to function, appearance and safety. Quality repairs may require additional time to assure the completion of that agenda. We appreciate your understanding and most of all the confidence you have placed with Brown Collision Center.Name* First Last Consent* I understand the above statement about rental vehicles.PERSONAL BELONGINGS - BROWN HIGHLY RECOMMENDS TAKING ALL PERSONAL BELONGINGS OUT OF THE VEHICLE BEFORE REPAIRS BEGIN (I.E. MP3 PLAYERS, GPS SYSTEMS, JEWELRY, MONEY, AND PERSONAL INFORMATION).BY INITIALING YOU UNDERSTAND THAT BROWN COLLISION CENTER IS NOT RESPONSIBLE FOR ANY PERSONAL ITEMS LEFT IN VEHICLE AND WAIVE ANY RIGHT FOR REIMBURSEMENT FOR MISSING ITEMS.Name* First Last Consent* I understand the above statement about personal belongings.REPAIR AUTHORIZATION - I hereby authorize the repair work herein to be performed along with the necessary material, and hereby grant you and/or your employees’ permission to operate the car or truck herein described on the streets, highways, or elsewhere for the purpose of testing and/or inspection. An express mechanics lien I hereby acknowledge on this vehicle to secure the amount of the repairs hereto. I further authorize Brown Collision Center to repair my vehicle per the insurance estimate and/or customer pay estimate, including all supplementary claims and hereby assume all personal liability for payment in full for any work performed on the said motor vehicle.Name* First Last Consent* I agree to the repair authorization.CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.