Terms *

I confirm that I have reviewed my vehicle and am satisfied with the repairs completed. I understand that any future concerns should be reported promptly.

I Accept

Name

First Name

Last Name

Date *

Today's Date

MM

DD

YYYY

Terms *

☑ I acknowledge that my vehicle is a total loss as determined by my insurance company. ☑ I authorize Onel Auto Body & Paint to release the vehicle information to my insurer or their authorized agent. ☑ I have removed all personal belongings from the vehicle. ☑ I understand that Onel Auto Body & Paint is not responsible for any items left inside the vehicle.

I Accept

Name *

First Name

Last Name

Phone *

Country

(###)

###

####

Date of Total Loss: *

MM

DD

YYYY

Total Loss Release Option *

In-Person

Verbal