RacTrak FasTrak©

RacTrak FasTrak© Certified Shop
RacTrak© Shop ID
Shop Emails
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDateHourMinutesAM/PM Option
17 Digit VIN (Vehicle Identification Number)
See photo as an example
Vehicle Year
Vehicle Make
Vehicle Model
If Pre-1995, list Year here
Color

Other
Mileage (Odometer - NOT KM)
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
Is there an Insurance Claim for these Damages?
Claim Info

Other
Date of Accident

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDateHourMinutesAM/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.
For RacTrak Personnel Only

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RacTrak FasTrak© Certified Shop