DIRECTION TO PAY

Cousin’s Collision Center
45 Foundry Street, Woonsocket, RI 02895-5120
Phone: 401-766-7679
Fax: 401-765-8028

Authorization to Repair

I hereby authorize Cousin’s Collision Center to perform repairs on my vehicle as described below, as per insurance company and/or customer’s request to before accident condition.

Direction of Pay

I, [CUSTOMER NAME], give [CUSTOMER’s INSURANCE COMPANY] permission to send all checks relative to the below referenced claim to Cousin’s Collision Center at 45 Foundry Street, Woonsocket, RI 02895-5120, which has preformed all repairs to my vehicle to my complete satisfaction.

Direction of Pay Form

Name *

Home Phone *

Cell Phone *

Email *

Address *

City *

State *

Zip Code *

Vehicle Make *

Vehicle Model *

Year of Manufacture *

Vehicle VIN # *

Registration *

Insurance Company *

Claim Number *

Electronic Signature *

Today's Date *

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CONTACT US TODAY

Cousin’s Collision Center is your prime auto location for everything from collision repair to custom paint jobs and classic car restoration. If you have any questions about our services, or if you’d like to set up an appointment, contact us today!