Customer Information Vehicle Hail Damage Assessment Form

To proceed with any insurance claims,

Step 1: Contact your insurance company and lodge a claim – we require a claim number.

Step 2: Please complete the following form on this page below.

Step 3: Contact us to make the FREE quotation and we will take the necessary compliant pictures of your vehicle for the insurance companies.

If you can promote us as your repairer you are eligible for our cashback reward.

Name *

First

Last
Email Address *
Address *
Suburb *
State
Post Code
Phone Number *
Phone Number (Secondary Contact eg Spouse)
Vehicle Information (Make, Model,Year, Colour) *

Toyota, Camry, 2015, White
Registration *
Are you open to going through insurance? *

Yes No
Claim Number
Insurance Excess
Insurance Company (choose no insurance if none or not going through insurance) *
If Insurance not listed please specify
Date (and Time) of Hail Damage Event
Location of Hail
Provide a picture of your vehicle with registration (optional)
Select Image
Further Comments or Requests
I consent to the information provided here to be used for the purposes of the quotation *

Click here to agree