Direction to Pay Form

Fill out the Direction to Pay Form below.

Direction to Pay Form

Owner Information(Required)

Vehicle Information:

Direction to Pay:

In the event the insurance or independent adjuster company inadvertently mails the settlement/supplement check to me in error, I agree to notify Autowerks NW immediately and deliver the check to our offices within 48 hours of receipt.

Payment Responsibility Acknowledgment

Autowerks N.W., Inc., as a courtesy to you, will work directly with your insurance company to arrange for the payment of repairs performed by Autowerks N.W., Inc., on the above referenced vehicle. You agree and acknowledge that in the event that the insurance company fails to pay Autowerks N.W., Inc. any amount due for repair services performed on your vehicle, including without limitation inspection, checkout, or other charges associated with inspection and repair of your vehicle, regardless of the reason for nonpayment, you accept responsibility for full payment to Autowerks N.W., Inc. any amounts due and remaining unpaid before your vehicle is released. It is further understood that any unpaid charges are due immediately upon notification to you by Autowerks, N.W. Inc.

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