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File Damage Claim
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Damage Claim Policy
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I have read and agree to the Damage Claim Policy
Injury Acknowledgement
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I acknowledge and affirm that neither I nor any occupant of the vehicle suffered bodily injury, physical injury, pain and suffering, medical damages, or any other personal injury arising from the incident described in this claim. This claim is limited solely to alleged vehicle property damage.
Damages Limitation and Waiver
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I acknowledge and agree that this claim is limited solely to the reasonable cost to repair or replace the specific physical vehicle damage alleged in this claim. I waive and release any claim against Zoom Express Car Wash for diminished value, loss of resale or market value, loss of use, rental expenses, depreciation, or other incidental, indirect, or consequential damages arising from the alleged incident.
Full Name
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Phone Number
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Email Address
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Date of Incident
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MM slash DD slash YYYY
Location
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Maitland
Colonial
Sanford
Vehicle Year
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Vehicle Make
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Vehicle Model
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Vehicle VIN #
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Vehicle Plate Number
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Name of manager that damage was reported to
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Description of Damage
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Photocopy of Driver's License
*
Max. file size: 64 MB.
Upload Images of Damage
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Max. file size: 64 MB.
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