Incident Report -J's Ultimate Hand Car Wash
To report an incident at our car wash, please provide the following information
Customer Name:
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
How do you want us to get in contact with you?
*
Phone
Email
No Preference
Do not contact me
Date and time when incident occurred:
*
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Year
Date Picker Icon
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Minutes
AM
PM
AM/PM Option
Vehicle Information:
*
Include make, model, year, and license plate number
Description of Incident:
*
Include area of car wash where incident occurred, location of damage, if any, important information
Image Upload:
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