Fillable state farm authorization and direction to pay form

Description
Print English Version Reset AUTHORIZATION AND DIRECTION TO PAY NEW YORK ONLY (You have the right to select any repair facility to repair your vehicle) Vehicle owner's name: Vehicle description: Year Make Model VIN Claim Number: Date of loss: I authorize(d) (Repairer) to estimate and repair my vehicle, unless it is an economic total loss. Vehicle Owner's Signature Date Date the vehicle is available for inspection:...
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state farm authorization and direction to pay form
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