RacTrak FasTrak© Demo

Date

MonthDayYear
DateHourMinutesAM/PM Option
Unit # Barcode Scanner
17 Digit VIN (Vehicle Identification Number)*
See photo as an example
Vehicle Year
Vehicle Make
Vehicle Model
If Pre-1995, list Year here
Color

BlackWhiteBlueGreySilverRedGreenBiegeOther
Mileage (Odometer)*
NOT Kilometers
Location - (Dropdown Can Be Made Available)
Repair Center Mgr - Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
E-mail*

Confirmation EmailMandatory to receive your estimate correctly
Phone Number*

Area CodePhone Number
Is there an Insurance Claim for these Damages?

YesNo
Claim Info*

Insured (your Insurance)Claimant (their Insurance)Not SureOther
Date of Accident

MonthDayYear
DateHourMinutesAM/PM Option
Insurance Company*
If Other, List Here
Claim #*
Damage 1 Area (AIAG Codes)*
Damage 1 Type (AIAG Codes)*
Damage 2 Area (AIAG Codes)
Damage 2 Type (AIAG Codes)
Brief Damage Description

300 Letters Max0/300
Circle the Damage Areas - Do NOT use the "X" Button, it deletes the entire Image. Only use the arrow buttons to make changes*
Mandatory Photos (Marked with *)

Before you begin, click on the Mandatory Photos Instructions button at the bottom of the page
VIN Plate (Dash-Windshield area)-Click Upload if correct*
VIN (Inside Drivers Door or Pillar)-Click Upload if correct*
Odometer (mileage) - Click Upload if correct*
Left Front Corner - Click Upload if correct
Right Front Corner - Click Upload if correct
RT Rear Corner - Click Upload if correct
License Plate - Click Upload if correct
Left Rear Corner - Click Upload if correct
Damage Photos Instructions - 3 Mandatory (Marked with *)

Before you begin, click on the Damage Photos Instructions button at the bottom of the page
Damage Photo 1 - Click Upload if correct*
Damage Photo 2 - Click Upload if correct*
Damage Photo 3 - Click Upload if correct*
Damage Photo 4 - Click Upload if correct
Damage Photo 5 - Click Upload if correct
Initial here to indicate that the info being submitted is accurate. *
The info obtained by this form is for the sole purpose of creating a damage estimate. All info will remain secure and confidential.

RacTrak©
1. Please click SUBMIT only once
2. Please be patient, as multiple photos may take a little longer to upload.
3. You will see a "Thank You" page once your submission uploads completely.
Should be Empty:

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