Bernard's Advanced Collision

Schedule An Appointment.

Please help us best serve you, by providing us with the information below!

Full Name:

Phone:

Email:

Address:

City:

State:

Zip Code:

Year:

Make:

Model:

Color:

VIN Number:

Your Insurance Company:

Deductable:

Date of Loss:MM/DD/YYYY

Your Adjuster:

Adjuster's Email:

Adjuster's Fax #:

Other Driver's Insurance Company

Are you having vehicle repaired here at our shop?

While your repairs are being performed, how would you like to be contacted?

Text.

Email.

Who is paying for the repairs?

How did you hear about Bernard's?

Has the Insurance Adjuster looked at your car?

Do you have your Insurance estimate?

Check from the Insurance?

Do you have another estimate from another shop?

What is your number one concern about the repairs to your vehicle?

How many passengers were in the vehicle?

Child safety seats?

Where were all passengers seated? Was there any loose or heavy cargo located in the vehicle, what and where?

What is your preference?

Do you have RENTAL CAR COVERAGE?