Release Authorization and Shop Repair Authorization

I hereby agree to utilize the MAPFRE Insurance CAR/EZ Program for the repair of my [Vehicle Information] Auto Body Clinic.

I further agree to allow the CAR/EZ Shop and Commerce Insurance to electronically expedite the repair process of my vehicle in accordance with Massachusetts Regulation 212 CMR.

I hereby authorize Auto Body Clinic to repair the above mentioned vehicle. I agree that I will be responsible to pay the above shop my deductible and any betterment assessed for the repair of my vehicle.

Direction To Pay

I hereby assign my policy benefits for collision/comprehensive repairs and authorize Commerce Insurance to pay AUTO BODY CLINIC directly for the damages in the amount of [damage amount] arising out of the accident on [accident date].