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Customer Information
Name:
Contact Number:
Email Address:
Vehicle Information
Make:
Model:
Year:
VIN:
Current Mileage:
Repair Needs
Description of the Problem:
Are there any warning lights on?
Yes
No
Description of any symptoms:
Previous Repairs
Have any repairs or diagnostics been done for this issue before?
Yes
No
Description of the related repair records if available:
Photos
Upload multiple photos of the damaged area (close-ups and wide shots):
Upload a photo of the entire vehicle (all sides):
Additional Information
Is the vehicle currently drivable?
Yes
No
Any structural issues noticed?
Yes
No
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