Toll Free (866) 426-2333	(920) 361-5100	270 Broadway St.	Berlin, Wisconsin 54923

Body Shop Request Form - Berlin

Your Full Service Auto Body Repair Shop

Free Estimates!
We service All makes and models
We Accept:
- Visa
- Master Card
- Discover
- And of course, Cash or Check!

Call for an appointment!

Tell us how we can help you.

What services do you need for your vehicle?
Services to be performed:	PaintWork Collision Work Panel and Repair Glass Installation Warranty repair Frame Work Fiberglass Work

Insurance Information:
Insurance Company:
Policy/claim #:

Please tell us about your vehicle:
*Vehicle Year:**
*Make:**
*Model:**
Series (if known):

Odometer Reading:
Odometer Units:	Miles KM

License Plate Number:
Vehicle Identification Number (VIN) (if known):

*Transmission:**	Automatic Manual

Drive Train:	2-Wheel Drive 4-Wheel Drive All Wheel Drive
Additional Vehicle Information: (Please limit to 40 words. Additional words will be cut off.)

Please tell us about yourself:
Professional Title:	Mr. Ms. Mrs. Doctor
*Name:** (First Last Suffix)
Address: (optional)
*City:**
*State/Province:**
*Zip/Postal Code:**
*Day phone:**	( ) - Ext.
Evening phone:	( ) - Ext.
Fax:	( ) -
Best time to contact:
E-mail:
Questions or Comments: (Please limit to 40 words. Additional words will be cut off.)
* Fields marked with an asterisk are required. You cannot continue until these blanks are filled.