INSTRUCTIONS Fill in the required information. Print frame and sign. Take to your mechanic/body shop and have them sign. Mail the form to Correspondence Address: PRIMUS Financial Services P.O. Box 680020 Franklin, TN  37068-0020

CERTIFICATE OF SATISFACTORY REPAIRS

Customer Name: 

Customer Account Number: 

Year:    Make:     Model: 

Vehicle ID Number: 

To whom it may concern:

The agreed repairs and/or replacements to the above vehicle have been completed.

 

Repairer's Signature:  _______________________________________     Date:  ________________

Repairs and/or replacements to my automobile have been completed satisfactorily by the repairer.  I authorize payment to be made directly to the repairer.

 

Customer's Signature:  ______________________________________     Date:  ________________