Reading 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. (781-944-0033), Address: 17-19 High Street,  City: Reading

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

Vehicle Owner Name:   Vehicle Owner Email:   Vehicle Model:   

State: MA, Zip code: 01867-3117

Claim Number:    , Vehicle Year: Vehicle Make: 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: Reading METLIFE DTP
Unique Document ID: de15112ef10506a64473a4abd80e635775422868
Timestamp Audit
August 23, 2017 2:52 pm EDTReading METLIFE DTP Uploaded by Stephen Arena - lisa@autobodyclinic.com IP 73.218.116.7