State Farm Authorization State Farm Authorization and Direction to Pay Form Name* First Last Vehicle Make, Model, Year* Vehicle VIN* Claim Number* Date of Loss* MM slash DD slash YYYY Consent* I authorize MAYER'S COLLISION CENTER INC to estimate and repair my vehicle, unless it is an economic total loss. .Signature*Date* MM slash DD slash YYYY Date the vehicle is available for inspection: Date* MM slash DD slash YYYY Consent* I have received a copy of the initial and final automated repair estimate.Consent* I authorize State Farm to pay MAYER'S COLLISION CENTER INC on my behalfVehicle Owner's Signature*Date* MM slash DD slash YYYY Δ
