Vehicle Check-in Form
"
*
" indicates required fields
1
Vehicle Info
2
Reminders
3
Accident Damages
4
Prior Damages
5
Warnings & Fuel
Owner/Designee Full Name
*
Repair Order #
Vehicle Make
*
Vehicle Model
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Vehicle Year
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Select Year
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
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
No
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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