Bullseye Dent Roseville (JOT FORM)

1
Howdy! What’s your zip code?* This field is required.(We need a valid 5 digit zip)
2
What year is the vehicle in question?* This field is required.
3
Which of these is closest in size to your dent(s)?* This field is required.
US Quarter
Baseball
US Dollar
Football
Soccer Ball
Larger
HAIL Damage
4
Is there damage to the paint?
YESNO
5
Could you live with that paint damage if the metal was straightened back to normal?
YESNO
6
It sounds like your vehicle has some paint damage that you are really concerned about. PDR repairs are amazing at bringing mangled metal back into shape, but when it comes to paint scratch repair, there are two choices: repaint the ENTIRE PANEL (expensive) or apply touch-up paint (doesn't look that good). If your car is black or white, touch up can look good enough for many, but metallics like silver or gold will look terrible. If you'd like to have a qualified technician take a deeper look at your case specifically, we can have one contact you and gather more information to help you make the most informed decision. Would you like a qualified tech to take a deeper look?
YESNO
7
What panel(s) is the damage on?* This field is required.
front fender
hood
roof
quarter panel
front door
rear door
rear decklid
bumpers
8
Do you want to involve your insurance?
YESNO
9
OK, How much is your insurance comprehensive deductible?
10
What is your name?* This field is required.
11
Are you selling/trading in the vehicle soon?* This field is required.
YESNO
12
Is the damage from a moving collision with another vehicle or from collision with something stationary like a pole or wall?
YESNO
13
It looks like your damage is possibly from a minor collision.PDR when performed at the highest level, is very effective for minor collision repair. There are, however a few factors that can limit repair viability that are best worked out over a quick phone call. Would you like to have a qualified technician reach out to you to see if your specific case qualifies? PLEASE CLICK 'SUBMIT' BELOW TO COMPLETE!
Yes, please have someone contact me!
14
Have you had paintless repairs done before?* This field is required.
YESNO
15
Were you pleased with results?
YESNO
16
What is your best email ?* This field is required.
example@example.com
17
When would you like to get started on this repair* This field is required.
Date
Year
Month
Day
18
Phone Number
19
Great! It looks like you qualify for Paintless dent Repair!

Please click SUBMIT below to complete!
Should be Empty: