Estimate

Estimate Request
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number
Please enter a valid phone number.
Email
example@example.com
Insurance (Responsible Party)
Enter the insurance company name or CUSTOMER PAY
Claim Number
If you have a claim number, enter it here
If you have the following information it is very helpful to us so we can communicate with the insurance company.
Adjuster's Name

First NameLast Name
Adjuster's Phone Number
Please enter a valid phone number.
Adjuster's Email
example@example.com
Please read the following acknowledgment and sign at the bottom. By signing I agree that I have read and agree to abide by the guidelines in this document.
1. If repaired by Highway 280 Paint & Body, a signed Direction to Pay is due upon drop off of my vehicle.
2. If owed, the deductible amount is due upon delivery of my vehicle.
3. Debit/Credit cards will be charged a 3% convenience fee.
Signature

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Estimate Request