Customer Repair Intake Form

IMPORTANT – PLEASE TAKE NOTE:
All vehicles dropped off MUST have a FULL TANK of gas due to road test and recalibrations of ADAS systems. Please remove all personal belongings from your vehicle before drop off including items in the trunk and back seats.

"*" indicates required fields

Name*

First Last

Phone*

Email*

How would you prefer to be updated during the repair process?*

Text

Phone

Your Insurance Company

Your Insurance Agent

Will you need a rental car?

Yes

Please tell us how you heard about Fuller’s Collision Center:

Fuller’s Collision Center offers the following services. Please select the service you wish to have.

Express Detail

Battery Test

Alignment

Additional Repairs

Please explain your additional repairs:

How did the accident happen?*

Do you have any questions or concerns about your vehicle?

Payment Consent*

I understand that Fuller’s Collision Center does not accept any credit card payments or combination of credit card payments over the amount of $2000.00. We accept cash or bank/cashiers check in any amount.*

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Comments

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2024

Fuller's Collision Center |