Schedule Your Appointment

* Indicates a required field

First Name

Last Name

Middle Initial

Phone

Cell Phone

Mobile Carrier

Prefered Contact Method

Phone

Cell PHone

I agree to receive text messages from $account.name. I understand that message and data rates may apply.

Address Information

Street

Apartment

City

State

Zip Code

Vehicle Information

Year

Make

Model

Referred By

Insurance Company

Deductable

Agents Name

Comments

Authorization to Repair

I hereby authorize the repair work to be performed along with the necessary material and agree that you are not responsible for loss or damage to the vehicle, articles in the vehicle, fire, theft, or any other cause that is not a direct result of your gross negligence or for delays caused by unavailable parts or delays in parts shipped by the supplier or transporter. I hereby grant you and/or your employees? permission to operate the vehicle herein described on streets or highways for inspection. An expressed mechanic?s lien is hereby acknowledged on above vehicle to secure the amount of repairs thereto. Customer is aware of damage noted on diagram, and agrees that it occurred prior to acceptance by Van Chevrolet. Customer agrees that he/she will be jointly and severally responsible and liable for payment of all charges for labor, parts, material and accessories, sublet repairs to the vehicle, and any other charges incurred under this Agreement, and payment in full shall be made prior to the release of the vehicle. If the vehicle is not picked up within ten (10) days after the dealership has notified the Customer that the repairs are completed, the dealership may charge daily storage fees at rates that are ordinary and customary for the area, but not to exceed $50.00 per day.

Check box above and type your name in box below for your digital signature.

Date

Grand Prairie Collision

701 East Palace Parkway
Directions Grand Prairie, TX 75050

: 877-640-6778

Monday 7:00 am - 6:00 pm
Tuesday 7:00 am - 6:00 pm
Wednesday 7:00 am - 6:00 pm
Thursday 7:00 am - 6:00 pm
Friday 7:00 am - 6:00 pm
Saturday 9:00 am - Noon
Sunday Closed

Appointment Scheduler

Address Information

Vehicle Information

Comments

Contact

Hours