This document serves as a formal and legally binding agreement between The Showroom Miami and the undersigned customer. By affixing your digital signature, you acknowledge your consent to the outlined repair services, terms, and conditions, and agree to comply with all relevant legal requirements. Please read carefully before proceeding.
Your Details:
Full Name
*
Phone Number
*
Format: (000) 000-0000.
Email Address
*
Street Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Description of Damage / Vehicle Problem
Photo of Driver's License
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Vehicle Details:
VIN #
*
Year
*
Make
*
Model
*
Color
*
License Plate #
*
mileage In
*
Photo of Damage
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Photo of Vehicle Registration
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Insurance Information (Required if using Insurance) :
Claim #
*
Insurance Company
Emergency / Alternate Contact :
Full Name
*
Relationship
*
Phone Number
*
Format: (000) 000-0000.
Written Estimate?
REQUEST A WRITTEN ESTIMATE
DO NOT REQUEST A WRITTEN ESTIMATE AS LONG AS THE REPAIR COSTS DO NOT EXCEED $_____ THE SHOP MAY NOT EXCEED THIS AMOUNT WITHOUT MY WRITTEN OR ORAL APPORVAL.
DO NOT REQUEST A WRITTEN ESTIMATE
Consent to Electronic Communications & Electronic Signatures
*
By checking this box, I agree to receive text messages from The Showroom Miami related to Appointment reminders, Vehicle inspection updates, Service confirmations at the phone number provided above. SMS frequency may vary. Data rates may apply. For assistance reply HELP. Reply STOP to opt out of receiving text messages. Please review our Privacy Policy and Terms and Conditions.
Signature
*
Date
*
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Month
/
Day
Year
Date
Date of Loss
-
Month
-
Day
Year
Date
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