Vehicle Repair Authorization

We’ve made it simple to authorize repairs to your vehicle online.
Complete the required information below, click the boxes to agree to the statements and sign with your finger or mouse before submitting.

Customer Information

First Name

Last Name

Cell Phone

Email address

Street Address

City

Zip

Vehicle & Insurance Information

Claim Number (If Known)

Check Amount

Number of people in vehicle at the time of accident?

Vehicle Part Selection Authorization

I prefer and authorize the use of new OEM parts in the repair of my vehicle

Clicking the boxes indicates you have read and agree to the following statement(s):

Legacy Toyota is not responsible for loss or damage to vehicles, articles, or personal property left in vehicles, in case of fire, theft, natural disasters or any other cause beyond our control. Please remove all personal belongings from your vehicle.

No car will be released until full payment is made. Deductible and insurance check or proof of loss must be received before vehicle will be released. Be certain all payee's (including lien holders) have endorsed the insurance check prior to completion of repairs.

The maximum payment using a credit or debit card shall not exceed $3000.00.

Vehicles that have sustained extensive damage could require more time to repair and exceed your rental coverage. Legacy Toyota will not be responsible for any rental expense in the event this occurs.

Authorization to Access Vehicle Data: I understand that modern vehicles are complex and that electronic data recorded in vehicle systems may help to diagnose necessary repairs and to confirm that applicable systems are functional after repairs are performed. I authorize Legacy Toyota to access this data as part of the diagnostic and repair process.

NOTICE PURSUANT TO SECTION 70.001, TEXAS PROPERTY CODE Customer understands that this vehicle is subject to repossession in accordance with Section 9.609, Texas Business & Commerce Code, if a written order of payment for repairs of the vehicle is stopped, or dishonored because of insufficient funds, no funds, or because the drawer or maker of the order has no account or the account on which it is drawn has been closed. I have read and agree to the Terms and Conditions.

I authorize Legacy Toyota to complete estimated repair work to be done along with the necessary materials. And hereby grant you, and/or your employees' permission to operate the vehicle herein described on streets, highways or elsewhere for the purpose of completing repairs, testing and/or inspection. An express mechanic's lien is hereby acknowledged on above vehicle to secure the amount of repairs thereto.

By using this service, you agree that Legacy Toyota may text you at the number provided. Message and data rates may apply.

Sign using a mouse (PC) or with your finger/stylus (Mobile).

Clear

By drawing your signature in the space provided above, and clicking the "complete authorization" button, you are consenting to use electronic records and signatures in connection with this transaction, confirming your name displayed above is correct and you understand and agree to the statements above as well as our Terms and Conditions for Use in Document Executions. Your electronic signature will be just as enforceable as signing the same document using a handwritten signature.
Digital Signature: 3137322e37312e3235342e323337
IP Address: 172.71.254.237 User Agent: Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; [email protected])

AUTHORIZATION DATE