Crash Parts Disclosure

Customer & Vehicle Information

First Name *

Last Name *

VIN *

Year *

Make *

Model *

Insurance Company

Claim Number

Parts Authorization

Please select which type(s) of parts you authorize for use in the repair of your vehicle. Your selection will guide how we write the repair estimate and what parts we order on your behalf.

NEW OEM Parts Only

I want only new original equipment manufacturer parts used on my vehicle. I understand this may result in a higher repair cost and my insurer may dispute the charges.

New or Used OEM Parts

I authorize the use of new or used OEM parts, with the exclusion of weld-on structural parts and glass. I understand that OEMs do not support the use of used parts due to safety concerns.

Alternative Parts

I authorize the use of alternative parts (aftermarket, reconditioned parts) commonly preferred by insurance companies, but not supported by OEMs. I understand this may affect my vehicle's value, safety, and warranties, and release Collision Claims Advisors from all liabilities thereof.

Case-by-Case Decision

I want to review and approve each part type on a case-by-case basis before it is ordered. I understand this may delay repairs as each part requires my individual approval.

Customer Acknowledgment

I acknowledge that I am financially responsible for the cost of all parts and labor associated with the repair of my vehicle, as previously agreed in my Repair Authorization. This form confirms my specific parts preference and documents my awareness of the differences between part types.

I understand that my insurance company may not agree to pay for the type of parts I have selected, depending on the terms of my policy. Any difference between what my insurer is willing to pay and the actual cost of the parts I have authorized is my financial responsibility.

I have been informed that my vehicle manufacturer may have published position statements or repair requirements regarding crash part usage, and I may request a copy of these recommendations from the Repair Facility.

Customer Signature *

Sign above

Date

Customer Printed Name