Repair Form / Direction To Pay

Email: estimates@texasdentcompany.com
Phone Number: (214) 499-8466
Tax ID: 81-3861792
Wilson Solutions INC DBA Texas Dent Company
Claim Specialist:

Customer Information

  :   :
  : :
  : :
  :   :
  :  

Rental

  :   :

Vehicle

  :   :
  :   :
  :  

Insurance

  :  
: :
: :

Adjuster

  : :
  : :

Direction To Pay

Power of Attorney / Direction to Pay: 

In consideration for Texas Dent Company Performance of Repairs, I appoint Texas Dent Company and its authorized agents as my attorney-in-fact, with power and authority, in any name and place, to endorse any check or draft made payable to me in payment for damage, in conjunction with or as a condition with or as a condition to receipt of the proceeds of the check or draft, and/or to sign a vehicle title for the transfer of the vehicle in the event the vehicle is abandoned or repossessed by Texas Dent Company in accordance with applicable law. I understand and agree that this power of attorney in coupled with an interest and may not be revoked until Texas Dent Company has received payment in full for the Repairs to the vehicle. This is a direction to pay Texas Dent Company.

Authorization

- I hereby authorize Texas Dent Company to complete the repairs on my vehicle(s), once approved by my insurance company.
- I agree that Texas Dent Company is not responsible for the loss or damage to this vehicle and or items left in the vehicle due to theft, fire, or any other reasons out of their control.
- I authorize Texas Dent Company to repair all damages back to pre-loss conditions, this includes
-(a) repairing existing parts to preserve the original integrity of the vehicle(s) safely manufacture access when necessary to maintain maximum value of the vehicle, and to determine which parts to be replaces (OEM, LKQ, After-market) or repair to operate, transport my vehicle as necessary.
- I acknowledge and agree that, before Texas Dent Company delivers or releases my vehicle, I agree to pay the entire cost of repairs and other amounts due hereunder and if any portion is paid by check or draft from an insurance company;
- I agree to obtain check or draft from insurance and deliver to Texas Dent Company, properly endorsed by all payees including any lien holder for payment.
- I acknowledge that PDR has a lifetime warranty and that any issues that are non-PDR related are to be claimed at the time of the vehicle's return or within 30 days of return date.
- I acknowledge that I will not post negative or derogatory remarks online or on any review site within those 30 days.
- Texas Dent Company has the first right to look at and or repair said problem and is not liable for any payment to other vendors.

Leave this empty:

Signature arrow sign here


Signature Certificate
Document name: Direction To Pay - William
lock iconUnique Document ID: dd6730df2e2a61d50ced070dce41fc4c27cb2e16
Timestamp Audit
June 20, 2024 5:12 pm CDTDirection To Pay - William Uploaded by Cody Wilson - cody@texasdentcompany.com IP 98.97.42.99
June 20, 2024 6:50 pm CDTWilliam Soares - wsoares@texasdentcompany.com added by Cody Wilson - cody@texasdentcompany.com as a CC'd Recipient Ip: 98.97.46.122
June 20, 2024 7:05 pm CDTWilliam Soares - wsoares@texasdentcompany.com added by Cody Wilson - cody@texasdentcompany.com as a CC'd Recipient Ip: 98.97.46.122
June 21, 2024 1:22 pm CDTWilliam Soares - wsoares@texasdentcompany.com added by Cody Wilson - cody@texasdentcompany.com as a CC'd Recipient Ip: 98.97.46.122
June 27, 2024 9:26 am CDTWilliam Soares - wsoares@texasdentcompany.com added by Cody Wilson - cody@texasdentcompany.com as a CC'd Recipient Ip: 98.97.46.23
June 27, 2024 9:26 am CDTCody Wilson - cwilson@texasdentcompany.com added by Cody Wilson - cody@texasdentcompany.com as a CC'd Recipient Ip: 98.97.46.23
July 3, 2024 11:36 am CDTWilliam Soares - wsoares@texasdentcompany.com added by Cody Wilson - cody@texasdentcompany.com as a CC'd Recipient Ip: 98.97.42.99
July 3, 2024 11:36 am CDTCody Wilson - cwilson@texasdentcompany.com added by Cody Wilson - cody@texasdentcompany.com as a CC'd Recipient Ip: 98.97.42.99
July 3, 2024 11:40 am CDTWilliam Soares - wsoares@texasdentcompany.com added by Cody Wilson - cody@texasdentcompany.com as a CC'd Recipient Ip: 98.97.42.99
July 3, 2024 11:40 am CDTCody Wilson - cwilson@texasdentcompany.com added by Cody Wilson - cody@texasdentcompany.com as a CC'd Recipient Ip: 98.97.42.99