Beverly METLIFE DTP


AUTHORIZATION TO REPAIR – DIRECTION TO PAY

Submit signed & completed form to MetLife Auto & Home as an attachment or as a digital photograph.

Original to be retained at shop and produced upon request.

 

Shop Name: Auto Body Clinic Inc. (978-922-3334), Address: 29 River Street, City: Beverly

State: MA, Zip code: 01915

Federal Tax Identification Number (TIN): 042-694-666, Claim Number:    

Vehicle Owner Name:  , Vehicle Owner Email:  , Vehicle Year: Vehicle Make: Vehicle Model: VIN:   

I hereby authorize said facility to commence repairs upon my vehicle.

Furthermore, I authorize MetLife Auto & Home to issue any payment to the aforementioned facility and, mail said payment directly to this repair facility.

Leave this empty:

Signature Certificate
Document name: Beverly METLIFE DTP
Unique Document ID: db5ac24b13e519185bb28f994ccc5d7f9e65300c
Timestamp Audit
August 23, 2017 1:28 pm EDTBeverly METLIFE DTP Uploaded by Stephen Arena - lisa@autobodyclinic.com IP 73.218.116.7