I, [Customer Name], the owner and/or authorized representative of the vehicle described above, hereby direct and authorize my insurance company, [Insurance Company], to issue payment for all covered repair costs directly to:
State Road Auto Body
5387 State Rd, Parma, OH 44134
This direction to pay applies to all insurance proceeds, supplements, and any additional payments related to Claim Number [Claim Number] for the repair of the above-described vehicle. This authorization shall remain in effect until all repairs are completed and all amounts due to the Repair Facility have been paid in full.
