Title Page
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Conducted on
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Prepared by
Car ID
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Car Number
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Car VIN
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Does your car have a camera?
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Does your camera have a sim card?
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Is your camera recording?
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Glass Damage
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Front Hood Damage
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Front Bumper Damage
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Front Driver Wheel Damage
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Front Driver Quarter Panel Damage
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Driver Front Door Damage
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Driver Rear Door Damage
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Rear Driver Wheel Damage
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Rear Driver Quarter Panel Damage
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Rear Hatch Damage
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Rear Bumper Damage
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Rear Passenger Quarter Panel Damage
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Rear Passenger Wheel Damage
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Passenger Rear Door Damage
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Front Passenger Wheel Damage
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Passenger Front Door Damage
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Front Passenger Quarter Panel Damage
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Undercarriage Damage
Signature
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Name
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Car
