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Authorization Form
You’re just a few clicks away from getting your vehicle on the road to recovery.
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Service Location
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Fremont
Grand Island
Hastings
Holdrege
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North Platte (2306 E Philip Ave)
North Platte (1220 N Custer Ave)
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Your Information
Name
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First
Last
Email
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Phone
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Your Vehicle’s Information
License Plate # or Last 8 of VIN
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Year / Make / Model
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Terms & Conditions
Please check the box(es) below to agree.
Authorization to Repair
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Authorization to Repair
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I hereby authorize Levander's to complete the necessary repairs to my vehicle. A Service Advisor will provide me with an oral/written evaluation. I understand that payment in full will be due upon release of the vehicle, including any supplemental charges. I hereby grant you and/or your employees permission to operate my vehicle on streets, highways, or elsewhere for the purpose of testing, inspecting or sublet repairs, and delivery or pick up. An Express Mechanic’s Lien is hereby acknowledged on above vehicle to secure the amount of repairs thereto. I will not hold Levander's responsible for loss or damage to vehicle or articles left in vehicle in case of fire, theft, accident, or any other cause beyond your control.
Authorization to Disassemble
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Authorization to Disassemble
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I authorize Levander's to disassemble my vehicle for the purpose of diagnosing repairs and preparing a full estimate of the cost of repair. I understand that if I choose not to complete repairs, I may be charged for disassembly, reassembly and/or partially completed work, based on Levander's normal hourly labor rate.
Authorization to Access Vehicle Data
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Authorization to Access Vehicle Data
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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 Levander's to access this data as part of the 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.
Direction to Pay
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Direction to Pay
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If an insurance carrier is paying for all or part of my repair order, I authorize payment to Levander's, or its affiliated companies. If a deductible is required, I will be responsible for payment. Furthermore, I authorize any and all supplement repair order amounts to be paid to Levander's.
Completion of Repair
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Completion of Repair
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The length of time to complete your vehicle’s repair may exceed customary time due to (i) parts availability (ii) material shortages and/or (iii) labor shortages. Due to these issues, the length of time to complete the repair may exceed the insurance company approved time for rental charges. Levander's is not responsible for rental charges beyond the insurance company approved rental period for issues outside of Levander's control. Levander's is not responsible for these costs and is not responsible if insurance coverage is not sufficient to pay these costs.
Additional Fuel Required
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Additional Fuel Required
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Please note that if your vehicle is equipped with one or more Advanced Driver Assist Systems (ADAS) – for example blind spot monitor, lane keep assist, distance cruise control, etc – part of the repair process may include calibration of those systems. To calibrate ADAS to original equipment manufacturer specifications, certain years, makes, and models require proper weight distribution including a full fuel tank. If your vehicle and repair requires additional fuel to be added, you will be responsible for the additional cost.
Transfer of Vehicle (Optional)
Transfer of Vehicle (Optional)
I understand that Levander's will periodically transfer vehicles from one center to another to speed repair times and take advantage of special expertise across its centers. I authorize Levander's to transport my vehicle to and perform all authorized repair work at another repair facility owned or operated by Levander's or one of its affiliates.
Removal of Personal Articles
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Removal of Personal Articles
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I acknowledge that I have removed or will remove all personal and valuable articles from the vehicle. I understand that Levander's will not be responsible for any belongings left in the vehicle.
Terms and Conditions
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Terms and Conditions
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I have read, understood and agree to the terms and authorizations contained in the terms and conditions governing Levander's repair services, including the Dispute Settlement & Arbitration provision. We recommend that you retain a copy for your reference.
Digital Communications
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Digital Communications
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By signing this authorization, you are agreeing to digital communication, digital reminders for updates, appointments, repair process, completion, marketing and future promotions from Levander's and its different affiliated businesses.
Electronic Signature
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