RacTrak© Certified Shop

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
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
E-mail*
Mandatory to receive your estimate correctly
Phone Number*

Area CodePhone Number
Mileage (Odometer)*
NOT Kilometers
Is there an Insurance Claim for these Damages?

YesNo
Claim Info*

Insured (your Insurance)Claimant (their Insurance)Not SureOther
Insurance Company*
If Other, List Here
Claim #*
Circle the Damage Areas - Do NOT use the "X" Button, only the arrow buttons to make changes*
Mandatory Photos Instructions (Mandatory Marked with *)

Match the Sample Picture shown to the right of each selection - NO BLURRY PHOTOS

If the Photo is NOT correct, click the DELETE button to retake the Photo

If the Photo IS correct, click the UPLOAD button to save the Photo

Your Photo has been Uploaded Correctly once you see this:
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 *)

TAKE PHOTOS IN A SAFE AREA AWAY FROM TRAFFIC !!!

See Samples Below
- 1- Step Back about 5-6 ft ( IF SAFE! ) & show SIDE & FRONT or SIDE & REAR
- 2- Close Up of DAMAGE
- 3- About 3 ft away from the DAMAGE
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 from this form is for the sole purpose of creating a damage estimate.

All info will remain secure and confidential. Thank you for using our service.

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