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Life is hard enough. Let us take the stress out of your claim process: (706) 596-1225

CUSTOMER INFORMATION

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Will You Be Using Rental Car Coverage During The Repair?
Yes
No
Has A Rental Reservation Been Arranged By The Insurance Company?
Yes
No

VEHICLE INFORMATION

AUTHORIZATION

North Columbus Collision Center, LLC, is hereby authorized to make the specified repairs to the above vehicle. I hereby grant North Columbus Collision Center employees permission to operate my vehicle on streets, highways, or elsewhere as necessary for the purpose of testing and or inspection. North Columbus Collision Center is not liable or held responsible for loss or damage to vehicle or articles left in vehicle in case of fire, theft, accident, or other cause or causes beyond the control of North Columbus Collision Center. I understand that my old vehicle parts will be disposed of unless otherwise instructed.


I understand that there may be a diagnostic test performed on my vehicle while it is at NCCC. I grant NCCC permission to perform this pre and post-repair diagnostic scan on my vehicle as part of the repair process. In the process of performing a diagnostic scan, NCCC will collect important historical vehicle data, including in some cases, the date, time and mileage of when a DTC was created. This information is helpful in understanding if a problem is accident related or pre-existing. Your acceptance of this procedure grants NCCC permission to share this information with others, including your insurance company. No personally identifiable information is collected during the pre or post repair scan.

I UNDERSTAND AND I AGREE:
Yes

I understand that this claim has a deductible and is my responsibility as the vehicle's owner to pay this amount in full, at the completion of the repair. 


Forms of payment accepted are: Insurance Checks, Personal Checks, Money Order, Cashiers Check, Cash, and Debit Card.


NCCC accepts Visa and MasterCard payments if the amount is less than $1,000. 


NOTE: Discover and American Express are not accepted.

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