Vehicle Incident Report – Zax Auto Wash – Your Ultimate Car Wash

Date(Required)

Time(Required)

:

Zax Wash Location(Required)

Choose the wash location where the incident happened.

License Plate Number(Required)

Last Four of VIN Number(Required)

Vehicle Make/Model/Trim(Required)

Vehicle Year(Required)

Vehicle Color(Required)

Name(Required)

First Last

Phone(Required)

Damage Location(Required)

Which part of vehicle was damaged?

Customer Statement(Required)

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