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Repair Order Header
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Customer Information
3
Vehicle Information
4
Keys & Personal Items Received
5
Insurance Information
6
Accident / Loss Details
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Functional Check At Intake
Mark items confirmed working
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Vehicle Damage Diagram
Click on the vehicle to add markers
Click 1× = New damage
Click 2× = Pre-existing
Click 3× = OK
Click 2× = Pre-existing
Click 3× = OK
Front View
Rear View
Driver Side (Left)
Passenger Side (Right)
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Photos At Intake
Mandatory: 4 exterior, odometer, VIN plate, dashboard
Click to add photos · or take new
JPG, PNG, HEIC · Up to 25 photos · Embedded in PDF
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Service Requested
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Repair Authorization
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Storage, Rental & Tow
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Disclosures & Consents
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Digital Signatures
Customer Signature
Service Advisor Signature
CENTURIN
AUTO COLLISION
AUTO COLLISION
CENTURION AUTO COLLLISION LLC
CONTROL NUMBER:
404-468-2192
3864D Centerville Hwy
Snellville, GA 30039
CONTROL NUMBER:
404-468-2192
3864D Centerville Hwy
Snellville, GA 30039
VEHICLE ENTRY DOCUMENT TO
CENTURION AUTO COLLISION
| DATE | |
| TIME | |
| TERMS | |
| ADVISOR |
Customer Information
| Name | Phone | ||
| Alt Phone | |||
| Address | |||
| Relationship | Preferred Contact | ||
Vehicle Information
| VIN Number | Year | Make | Model | Color |
|---|---|---|---|---|
| Trim | Interior | ||
| License Plate | Mileage | ||
| Fuel Level | Battery | ||
| Tires | Dashboard Lights |
Keys & Personal Items Received
| Keys | Remotes / Fobs | ||
| Valet Keys | Special Keys | ||
| Personal Items Inventory | |||
Insurance Information
| Pay Type | Claim Type | ||
| Insurance Company | Policy # | ||
| Claim # | Deductible | ||
| Adjuster | Adjuster Phone | ||
| Adjuster Email | |||
Accident / Loss Details
| Date Of Loss | Time | ||
| Location | |||
| Police Report # | Vehicle Towed | ||
| Airbags Deployed | Injuries Reported | ||
| Customer Description | |||
Functional Check
Vehicle Damage Diagram
Legend: ● Red = New damage · ● Yellow = Pre-existing · ● Green = OK
Damage Notes:
Photos At Intake
Service Requested
Services:
Description:
Repair Authorization
Authorization Limit: | Estimated Cost:
Storage, Rental & Tow
| Tow Company | Tow Charges | ||
| Need Rental | Rental Insurance |
Storage Policy: Vehicles not picked up within 5 business days after completion notification incur a $50/day storage fee. Vehicles abandoned beyond 60 days are subject to lien sale per Georgia Code §40-11.
Clauses
- Customer authorizes Centurion Auto Collision to perform necessary repairs on the vehicle listed above.
- The customer understands that local spare parts have a delivery time of 1 business day, while spare parts that require connection with shipping companies, such as FedEx, UPS or USPS, have a delivery time of 4 business days from the date the order is placed.
- Delivery times mentioned in the above clause are estimates and may vary depending on the availability of spare parts and circumstances beyond the control of Centurion Auto Collision.
- Centurion Auto Collision is not responsible for the loss or damage of personal items left in the vehicle by the customer, including but not limited to keys, glasses, watches and other personal items. The company does not assume responsibility for these elements because the workshop focuses exclusively on vehicle repairs and painting.
- The customer understands that the prices quoted are estimates and may be subject to adjustments based on the technical evaluation performed once the vehicle enters the workshop. The customer will be informed of any significant changes in cost before proceeding with additional repairs.
- If the vehicle is from an insurance process, the release of the repaired vehicle will only be made after approval and disbursement of funds by the insurance company. The client agrees to collaborate in the claim process, and attach all pertinent information so that we can continue the process mutually with the insurance company.
- Customer acknowledges that hidden damage may be discovered during repair. Any additional damage will be documented, photographed, and communicated before further work begins.
- Customer authorizes the use of OEM, aftermarket, or LKQ (used) parts as deemed appropriate for safe and quality repair, unless otherwise specified by insurance policy.
- Customer consents to receive SMS, phone calls, and emails from Centurion Auto Collision regarding the status of this repair.
- Any disputes arising from this repair will first be addressed in writing between the customer and Centurion Auto Collision before escalation to mediation, arbitration, or court action, in accordance with Georgia state law.
Customer Acknowledgments
SATISFACTION GUARANTEE
Customer Signature · Date:
Service Advisor · Date:
This document constitutes the official intake record of the vehicle described above at Centurion Auto Collision LLC. By signing, the customer confirms the accuracy of all information provided and agrees to all clauses and disclosures listed in this document. A digital copy of this document will be sent to the customer’s email upon request.