DIRECTION TO PAY

I authorize ____________________ Insurance Company to pay Carubba Collision directly for repairs done to:

Year______________ Make_____________ Model_________________

Plate #_________________ Serial # ________________________

Claim # _______________________________________

Total _______________________________

I do hereby appoint the aforementioned business to accept on my behalf any and all checks, drafts, or bills of exchange, and to endorse all such checks, drafts, or bills of exchange for deposit to the aforementioned business account for credit on my account for repairs on my vehicle which has been released and accepted.

Signature_____________________________________