Appointment for Estimate

Direction to Pay & Repair Authorization

Complete this secure form to authorize Ray’s Body Shop & Wrecker Service to communicate with your insurance company, perform approved collision repairs, and receive payment directly from the insurance carrier for covered repairs.

Customer Information

Vehicle Information

Insurance & Claim Information

Authorization

I authorize Ray’s Body Shop & Wrecker Service to inspect my vehicle, prepare repair estimates, communicate with my insurance company, submit repair documentation, and perform approved repairs. I further authorize my insurance company to issue payment directly to Ray’s Body Shop & Wrecker Service for covered repairs, supplements, parts, labor, materials, storage, towing, or related charges connected to this claim.

I understand that I remain responsible for any deductible, betterment, prior damage, non-covered charges, or any balance not paid by the insurance company.

By typing your name above, you agree that your electronic signature has the same effect as a handwritten signature.

Ray’s Body Shop & Wrecker Service

Address: 4345 South Main Street, Winston-Salem, NC 27127
Phone: 336-788-6174
Website: raysbodyshopandwrecker.com