Customer Information

    Vehicle Information

    Dent Damage Information

    Number of Dents*

    Approx Size

    Paint Damaged

    Cracked / Scratched Paint

    YesNo

    Damage Locations

    A - Front BumperB - HoodC - FenderD - RoofE - DoorF - Quarter PanelG - Trunk / LiftgateH - Rear Bumper

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    Number of Dents

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