Detailed Service Request

1

Name* This field is required.

First Name

Last Name

2

Address* This field is required.

Street Address

City

State

Postcode

Country

3

E-mail

example@example.com

4

Phone Number* This field is required.

5

YOUR VEHICLE* This field is required.

6

Year and Build Month* This field is required.month and year (from compliance plate - most commonly located in either driver or passenger door or under the bonnet) PLEASE ATTACH AN IMAGE OF THE COMPLIANCE PLATE WITH YOUR PHOTOGRAPHS

7

Does Your Vehicle Require Towing:-

YESNO

8

Tow Needed

Location of vehicle

where is the key for this vehicle

9

Insurance or Private Work* This field is required.

Insurance

Private

10

Insurer

Insurance Company

11

Has an insurance claim been lodged?

YESNO

12

Claim Number

13

Provide CLEAR images of damage that you want estimated by EITHER i) attaching below (SCROLL TO BOTTOM OF LOADING PAGE AND CLICK ON 'ADD', once loaded click on SUBMIT) or ii) send images to mobile 0417 688 752 then click SUBMIT below1. One image from each corner of vehicle 2. Close up of damaged panel/panels 3. Overview shot of damaged panel/panels 4. Registration plate 5. VIN/Compliance plate 6. Odometer

14

COVID-19 - Have you, or anyone in your immediate household, visited a nominated covid hotspot in the last fourteen days?* This field is required.

YESNO

15

COVID-19 Have you been in close contact with anyone suspected of or confirmed with Covid-19?* This field is required.

YESNO