Vehicle Incident Report Form Zax Auto Wash

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* Date:

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* Time of Incident:

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* Wash Location:

ANN ARBOR

AUBURN HILLS

BELLEVILLE

BRIGHTON

CHELSEA

CLARKSTON

CLINTON TWP

FARMINGTON HILLS

LIVONIA I- 29067 Plymouth Rd.

LIVONIA II- 36001 Plymouth Rd.

SALINE

STERLING HEIGHTS

TAYLOR

WATERFORD

WESTLAND

WIXOM

YPSILANTI

Vehicle Incident Report Form Zax Auto Wash

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* Date:

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* Time of Incident:

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* Wash Location:

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* License Plate Number:

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* Last Four Of VIN Number:

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* Vehicle Make:

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* Vehicle Model/Trim:

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* Vehicle Year:

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* Vehicle Color:

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* Customer Name:

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* Phone Number:

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* Damage Location:

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* Customer Statement: