Quick Hail Estimate

Quick Hail Estimate

11450 Cherokee St. Unit A2 Northglenn, CO 80234
Customer Information
Date

MonthDayYear
Date
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*
Insurance Company
Claim Number
Deductible
Vehicle Was Located
Vehicle Information
Year*
Make*
Model*
Color*
Plate*
VIN*
Mileage*
HailRise will provide a comprehensive repair estimate for this vehicle once the customer has dropped it oF at our repair facility, along with any necessary insurance information and signed authorization or direction to pay documents.

The customer acknowledges and agrees that this preliminary estimate is not a comprehensive or final repair estimate for the vehicle specified above.
Signature*

Clear
Date

MonthDayYear
Date

Authorization to Repair
Customer Name*
Phone #*
Address

Address

Street Address Line 2

CityState / Province

Zip code
I hereby authorize HailRise to make repairs in accordance with its written estimate or that written by my insurance company. I also authorize the purchase of parts and materials necessary for said repairs. I hereby authorize employees of HailRise to operate my vehicle for the purpose of testing, inspection and delivery. I understand that is my responsibility to remove personal belongings from my vehicle prior to repair and will not hold HailRise or its employees responsible for loss or damage to the vehicle or personal property left in the vehicle.
Vehicle Yr/Mk/Md/Cl*
VIN #*
Insurance Company*
Policy Number*
Mileage*
Plate#*
Do you have an initial estimate?*

YesNo
Have you received an insurance check?*

YesNo
Have you cashed the insurance check?*

YesNo
Do you have rental coverage?*

YesNo
How much is your Deductible?
Customer Name*
Signature*

Clear
Date

MonthDayYear
Date
Should be Empty:

Authorization to Repair