Terms *

I, the undersigned, have walked through my vehicle and am satisfied with the repairs performed. I understand that any additional concerns or issues should be reported promptly.

I Accept

Name

First Name

Last Name

Date *

Today's Date

MM

DD

YYYY

Name *

First Name

Last Name

Phone *

Country

(###)

###

####

Date of Total Loss: *

MM

DD

YYYY

Terms *

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

I Agree