Schedule A Repair – Please Fill in Completely!
The more you fill in, the more accurately
we can help you.

Your Contact Information

*Only These Six (6) Form Fields Are Required:

(Name, Zip, Phone, Year, Make & Model of vehicle)

* Name:

Address:

City:

State:

* Zip:

* Phone:

Email:

Your Vehicle Information

* Year:

* Make:

* Model:

Other:

What Caused Your Dent(s)? (select as applies)

Not Sure or Other (Please Describe)

What Best Describes the Size of Your Dents?
(choose the best answer and add more info if necessary)


Not Sure or Other (Please Describe)

Please Indicate Damaged Panel Location(s)

 LFF
 LFD
 LRD
 LRQ
 HOOD
 ROOF
 RFF
 RFD
 RRD
 RRQ
 TRUNK

Where is the Dent Located on the Panel?

How Many Dents Do You Need Repaired?

Does Your Dent have Paint Damage?

(choose the best answer and add more info if necessary)

Any additional comments regarding the damage to your vehicle?


FACTORS (check all that apply)



Add a photo or video (if using a smartphone) of your dent (A picture (max 8mb) is worth a thousand words, video (max 12sec or 8mb) is worth a million!)

Supported upload types: .jpg, .jpeg, .png, .mov, .mp4, .m4v (typical photos and smart phone videos)