Customer Information
Preferred Method of Contact
Vehicle Information
Insurance Information
Will an Insurance claim be submitted for Vehicle Damages?
Payment Agreement
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Notice Pursuant to Texas Property Code § 70.001

I warrant and represent that I am the owner of the above described vehicle or an authorized agent of the owner. I acknowledge and understand that All Car Collision, Inc. ("ACC") will have an express mechanic’s lien on and a security interest in the vehicle until such time as all indebtedness is paid in full. I further acknowledge and agree that: (1) if the vehicle is released by ACC, the vehicle remains subject to ACC’s mechanic’s lien and/or security interest until such time as all indebtedness is paid in full; and (2) because the vehicle is subject to repossession in accordance with Section 9.609 of the Texas Business and Commerce Code, ACC has the right to repossess and sell the vehicle in satisfaction of its lien or security interest if: (a) the indebtedness remains unpaid for 30 or more days; (b) any check, draft or negotiable instrument is declined, stopped, or dishonored for any reason; or (c) the drawer or maker of the order has no account or the account on which it is drawn has been closed.

Additional Terms & Conditions

Please have the business insert its complete, approved Additional Terms & Conditions here before using this form.

E-Signature Agreement

By typing my name and contact email address below, I confirm that I agree to the electronic submission of this Work Authorization to ACC and I accept that the information provided constitutes my legally binding digital signature.