4930 N. Galloway Ave
Directions
Mesquite
,
TX
75150
:
877-212-7967
About Our Shop
We are still here to meet your transportation needs.
Click here for the latest on our response to COVID-19.
HOME
APPOINTMENTS
OUR WORK
BEFORE & AFTER
TESTIMONIALS
ABOUT
STAFF
DIRECTIONS
CONTACT
Schedule Your Appointment
Virtual Repair Authorization
First Name
*
Last Name
*
Middle Initial
Email
*
Phone
*
Cell Phone
*
Mobile Carrier
Prefered Contact Method
Phone
Cell PHone
Email
I agree to receive text messages from Trophy Collision. I understand that message and data rates may apply.
Address Information
Street
Apartment
City
State
Select State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Guam
Puerto Rico
Zip Code
Vehicle Information
*
Year
Make
Model
Referred By
Insurance Company
*
Deductable
Agents Name
Comments
Authorization
I hereby authorize the repair work to be performed along with the necessary material and agree that you are not responsible for loss or damage to the vehicle, articles in the vehicle, fire, theft, or any other cause that is not a direct result of your gross negligence or for delays caused by unavailable parts or delays in parts shipped by the supplier or transporter. I HAVE REMOVED ALL PERSONAL ITEMS FROM MY VEHICLE, INCLUDING BUT NOT LIMITED TO CASH, JEWELRY AND ALL AUDIO/VIDEO EQUIPMENT. I UNDERSTAND THAT THE TROPHY COLLISION CENTER IS NOT RESPONSIBLE FOR PERSONAL ITEMS DECLARED AS MISSING OR DAMAGED. I hereby grant you and/or your employees permission to operate the vehicle herein described on streets or highways for inspection. An expressed mechanic's lien is hereby acknowledged on above vehicle to secure the amount of repairs thereto. Customer understands that prior damages are notated by office staff and used as a reference during the extent of the repairs. Customer agrees that he/she will be jointly and severally responsible and liable for payment of all charges for labor, parts, material and accessories, sublet repairs to the vehicle, and any other charges incurred under this Agreement, and payment in full shall be made prior to the release of the vehicle. If the vehicle is not picked up within ten (10) days after the dealership has notified the Customer that the repairs are completed, the dealership may charge daily storage fees at rates that are ordinary and customary for the area, but not to exceed $50.00 per day.
Check box above and type your name in box below for your digital signature.
Date
Submit
AdChoices