New Customer Intake Form

New Customer Intake Form
Contact Information
Name

First NameLast Name
Preferred Name
*Optional
Preferred Pronouns
*Optional
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please Upload photos of your Driver's License

This helps us confirm your identity, ensure the vehicle is released to the correct person, and keep your insurance claim accurate and secure.
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I plan to:

Insurance Information
Your Insurance
Please enter even if you are going through another party's insurance
Other Party's Insurance
If there is no other party, or the other party is uninsured, type "NA."
Claim Number
Claimant or Insured?
I confirm that I have contacted my insurance company and verified that this claim has active coverage for this repair. I understand that having a claim number does not guarantee coverage or payment approval.
Adjuster Name

First NameLast Name
Adjuster Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Adjuster Email
example@example.com
Type of Loss
Date of Loss

MonthDayYear
Date
Deductible
If going through Subrogation, the insurance will reimburse your deductible

If you claimed a Hit and Run, Vandalism, Mother Nature related, see if your deductible can be reduced if you have Uninsured Motorist or Comprehensive Coverage on your policy.
Do You Need a Rental?
Do You Have Rental Coverage on Your Policy?
Rental Preference
Skip if rental is not needed. If unsure, economy will be the default. Prices and availability may vary; contact rental company for more information.
Rental is 100% covered when the other party's insurance accepts liability and/or you have full coverage on your insurance.

If you are the insured, do you have rental coverage on your policy? Call your insurance to confirm.

We recommend Enterprise for your rental. Enterprise will pick you up at our shop!
Please Upload photos of your Insurance Card

If going through the other party's insurance, please still upload your own insurance card (this is for record-keeping, not billing purposes).
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Please upload a Copy of your preliminary estimate

If you have a preliminary estimate from your insurance or another shop, please upload it here. It helps us review your claim faster, prepare more accurate repairs, and avoid delays once your vehicle arrives.
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Vehicle Information
Please be sure all damages related to the accident are reported to your insurance claims handler for transparency
VIN Number
Year
Make
Model
License Plate Number
State
Color
Is Your Vehicle Safe to Drive?
Cause of Damage
Related Damage
Example: "Front Bumper" or "Left Driver's Door"
Unrelated Damage
If there are any prior damages to your vehicle, please state them here.
Upload photos of damages

*Optional
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Disclaimer: For vehicles that are towed in and do not receive an in-person walk-around inspection with the customer, we will perform repairs based on the damages described by the customer and the photos provided. Damages not documented or made aware to us may not be addressed. If you would like to perform an in-person inspection, please contact us to schedule a time to come in.

Additional Information
How Did You Hear About Us?
We want to thank our referrals as we are a family business since 1997
If there is anything else you need us to know about your vehicle or claim or if you have any questions, let us know here.
Please notify your insurance and obtain repair authorization before bringing your vehicle to our shop.

Once your car arrives, the repair process works as follows:

• Full teardown and inspection to identify visible and hidden damage
• A complete pre-loss repair estimate is written and submitted to your insurance
• Insurance review and approval. This step can take time, especially if the claim is under review, disputed, or requires supplements. If there is a disagreement on the scope or cost of repairs, you may have the right to appraisal through your policy.
• Your insurer may approve the estimate remotely or send a field appraiser for an in-person inspection
• Vehicles with safety systems such as blind spot monitoring require OEM scanning and calibrations

After approval, we verify parts availability. Parts delays and national backorders are common and outside of our control. We will provide parts ETAs directly from our vendors.

Repairs do not begin until all approvals are received and all parts are in hand. When factoring in insurance approval, supplements, inspections, and parts delays, the overall process can sometimes take several weeks or up to a month before repairs are completed.

Insurance companies, parts vendors, freight carriers, and supply chain issues may cause delays beyond our control.

We appreciate your patience as we work through the repair process together. If you have any questions at any point, please reach out.
Clicking "Submit" will take you to our Work and Payment Authorization form. Please sign if you have not already.
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New Customer Intake Form

Contact Information

Insurance Information

Vehicle Information

Additional Information