Online Authorization

We understand that life can be busy and a extra trip back to our shop may not be an easy feat. Relieve the hassle of coming back to our facility by filling out our online authorization form and we will be in contact with you as soon as possible to verify your approval. If you have any questions, feel free call us at (631) 264-3442.

* = Required

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Name *

Today's Date *

Address *

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Insurance Company *

Claim #

Vehicle Year *

Vehicle Make *

Vehicle Model*

VIN #

Vehicle License Plate # *

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How would you like to be contacted? *

Text

Email

Phone Call

Home Phone

Cell Phone *

E-mail *

How did you hear about us?

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Enter characters below:

Your authorization was successfully sent!
We will contact you to verify your request.