Advance Auto Repairs | Queens, NY

Name:

Email:

Phone:

Year:

Make:

Model:

Plate #:

Insurance Company:

Policy #:

Date of Accident;

Time of Accident:

Location of Accident:

Accident Report:

Damage Report:

Has a claim been filed:

Yes

No

Not Sure

Claim #:

Police Report Filed: (Upload File)

Yes

No

Not Sure

Were there any Injuries:

Yes

No

Not Sure

Air Bags Deploy:

Yes

No

Not Sure

Is vehicle drivable:

Yes

No

Not Sure

Select drop off Location:

Select a drop off Date:

Drop off Time:

Photos or Documents: (Optional)

INSURANCE COLLISION CLAIM