I hereby assign all insurance benefits, rights, and proceeds under my policy of insurance to Carefree Windshield Repair Inc. for services rendered in connection with the repair and/or replacement of my vehicle’s windshield.

This assignment includes, but is not limited to, the right to receive any and all insurance payments, benefits, and proceeds due to me under my insurance policy. Carefree Windshield Repair Inc is authorized to submit insurance claims, receive payments, and negotiate with my insurance company on my behalf.

Authorization to Submit Claims:

I hereby authorize Carefree Windshield Repair Inc. to submit claims on my behalf to my insurance company for the services provided. This includes, but is not limited to, providing necessary documentation, communications, and follow-up related to the claim process.

I understand that by executing this Assignment of Benefits, I am transferring my rights to insurance benefits to Carefree Windshield Repair Inc. and that this assignment is irrevocable.