Facts of Loss | Schaefer Autobody

Name*

First Last

Vehicle*

Folder # (optional)

Were you driving?

If not, who?

Phone # of driver if not you.

Approximate Speed:

Number of People in vehicle:

What Seats were occupied during the accident? Please check one:

Driver Front
Passenger Front
Driver Rear
Passenger Rear
Third Row

Was the vehicle pushed into a curb?

Did the vehicle go off road?

Were there any dash lights on prior to the accident? (i.e. - airbag, check engine, tire pressure, windshield fluid, steering, change oil, etc.)

Were there any dash lights on after to the accident? (i.e. - airbag, check engine, tire pressure, windshield fluid, steering, change oil, etc.)

Facts of Loss. Tell us what happened during the accident to better assist our Technician with the repairs:

Was anything inside the vehicle that could have caused damage to the interior? (i.e. a cup of coffee, a soda, anything heavy to damage door panels or windows, etc)

Are there any areas of damage on the vehicle NOT related to this accident?

Repair Location*

Signature*

Date*