ACCIDENT REPAIR REPORT
Was the vehicle moving or stationary when the accident occurred? StationaryMoving What seatbelts were in use during the accident? Driver FrontDriver RearPassenger FrontPassenger Rear Was There a child car seat in the vehicle at the time of the accident? YesNo Did you feel the impact of the accident? YesNo Does the vehicle drive or act different after the accident? YesNo If Yes please explain: Does your vehicle have any type of Ceramic Coating? YesNo Any other information:
Name: Date:
