Repair Submission Form Vehicle Name and Date Vehicle Repairs --- not set --- Repair Status Ready for Review Pending Shop Approval Customer Approval/Payment Repair in Process Repair Complete Vehicle Owner ID Facility Info Facility Type --- not set --- Dealership Independent Shop Self maintained Dealership # (if applicable) Facility Name Facility Address Facility Phone Want to receive text updates? Yes No Text Number Service Rep Info Service Rep Name Service Rep Email Repair Info Vehicle's Current Mileage Customer Concerns First Concern Describe the problem Describe the customer's concern with the vehicle Labor Estimate 20 minutes = 0.3 hours Hourly Rate Part Number & Price Place large/expensive parts on their own line with the price. Small parts can be grouped into one "misc" line. Add new Total estimate for this concern Add another concern Yes No 2nd Concern Describe the problem Parts Number & Price Place large/expensive parts on their own line with the price. Small parts can be grouped into one "misc" line. Add new Labor Estimate (in hours) Labor Rate Concern Total Add 3rd concern? Yes No 3rd Concern Describe the problem Parts Number & Price Place large/expensive parts on their own line with the price. Small parts can be grouped into one "misc" line. Add new Labor Estimate (in hours) Labor rate Estimate total Add 4th concern? Yes No 4th Concern Describe the problem Parts Number & Price Place large/expensive parts on their own line with the price. Small parts can be grouped into one "misc" line. Add new Labor Estimate (in hours) Labor rate Concern Estimate Total Add 5th concern? Yes No 5th Concern Describe the problem Parts Number & Price Place large/expensive parts on their own line with the price. Small parts can be grouped into one "misc" line. Add new Labor Estimate (in hours) Labor rate Concern Estimate Total Add 6th concern? Yes No 6th Concern Describe the problem Parts Number & Price Place large/expensive parts on their own line with the price. Small parts can be grouped into one "misc" line. Add new Labor Estimate (in hours) Labor rate Concern Estimate Total Add 7th concern? Yes No 7th Concern Describe the problem Parts Number & Price Place large/expensive parts on their own line with the price. Small parts can be grouped into one "misc" line. Add new Estimate (in hours) Labor rate Concern Estimate Total Add 8th concern? Yes No 8th Concern Describe the problem Parts Number & Price Place large/expensive parts on their own line with the price. Small parts can be grouped into one "misc" line. Add new Labor Estimate (in hours) Labor rate Concern Estimate Total Add 9th concern? Yes No 9th Concern Describe the problem Parts Number & Price Place large/expensive parts on their own line with the price. Small parts can be grouped into one "misc" line. Add new Labor Estimate (in hours) Labor rate Concern Estimate total Add 10th concern? Yes No 10th Concern Describe the problem Parts Number & Price Place large/expensive parts on their own line with the price. Small parts can be grouped into one "misc" line. Add new Labor Estimate (in hours) Labor rate Concern Estimate Total Estimate Total Please validate reCAPTCHA
