11101 Wallisville Road
Houston, TX 77013

(713) 673-3050

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I warrant and represent that I am the owner of the above described vehicle (hereinafter “the vehicle”) or an authorized agent of the owner and that Autos R Us Collision Center is authorized to repair the vehicle and provide the necessary services, part, and materials needed for the repair. I further authorize Autos R Us Collision Center employees to operate the vehicle on streets and elsewhere for the purpose of testing and/or inspection. I acknowledge and understand that Autos R Us Collision Center will have an express mechanics lien on and a security interest in the vehicle until such time as all indebtedness is paid in full. I further agree that Autos R Us Collision Center shall not be responsible for loss or damage to articles left in the vehicle in case of fire, theft or any other cause. I further authorize Autos R Us Collision Center to be my representative to negotiate with any insurance company/representative regarding the restoration of the vehicle to pre-accident condition and value. Autos R Us Collision Center is authorized to endorse drafts from insurance company securing payment.