Vehicle Check-in Form

1Vehicle Info

2Reminders

3Accident Damages

4Prior Damages

5Warnings & Fuel

Owner/Designee Full Name*

Repair Order #

Vehicle Make*

Vehicle Model*

Vehicle Year*

License Plate*

License State*

Odometer*

Please make sure to check the following*

Tick all whether it’s done or not applicable

Garage Door Opener

Parking Permit

Items in Trunk

Child Seat

Cell Phone / Charger

Other Valuables

Indicate Accident Damages*

In reference to the picture shown

1. Right Front Cornor

2. Right Front Side

3. Right Side

4. Right Rear Side

5. Right Rear Cornor

6. Rear

7. Left Rear Cornor

8. Left Rear Side

9. Left Side

10. Left Front Side

11. Left Front Cornor

12. Front

13. Rollover

Accident Description*

brief description of what happened

Indicate Prior Damages*

In reference to the picture shown

0. Nothing

1. Right Front Cornor

2. Right Front Side

3. Right Side

4. Right Rear Side

5. Right Rear Cornor

6. Rear

7. Left Rear Cornor

8. Left Rear Side

9. Left Side

10. Left Front Side

11. Left Front Cornor

12. Front

13. Rollover

Prior Damage Note*

including glass, interior damages, etc.

Warning Indicators

Please indicate any Warning Indicators on instrument panel (prior or related to this accident), if any.

Current Fuel Level*

Almost empty

About quarter

Half

More than half

Almost full

Fuel Filling*

If needed, a half tank of fuel will be filled in to your vehicle and the fuel charge will be added to your bill.

I agree

Your Comments

or estimate request for non-accident, if any.

Auto Detailing 20% Discount*

Are you interested in a 20% DISCOUNT on our Auto Detailing services?

Yes

Owner/Designee Signature*

I acknowledge that the condition of the vehicle as indicated above is accurate to the best of my knowledge.

Comments

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