Incident Report For Northern Lights Carwash Name(Required) First Last Email(Required) Enter Email Confirm Email Phone(Required)Address(Required) Street Address Address Line 2 City Province Postal Code Date of Incident(Required) MM slash DD slash YYYY Time of incident(Required) Hours : Minutes AM PM AM/PM Are you a member?(Required)Yes I Am A MemberNo I Am Not A MemberLicense plate number(Required)VIN of vehicle(Required)Mileage (KM)(Required)Please enter a number from 0 to 1000000.Year/make/model(Required)Where at the wash did the incident happen?(Required)Parking lotBeginning of washMiddle of washEnd of washUnknownPicture of VIN(Required)Accepted file types: jpg, png, heic, Max. file size: 6 MB. Picture of the receipt(Required)Accepted file types: jpg, png, heic, Max. file size: 6 MB. Picture of damage (3 Max)(Required) Drop files here or Select files Accepted file types: jpg, png, heic, Max. file size: 6 MB, Max. files: 3. Where is the damage on the vehicle?(Required) Front Bumper Assembly (Includes: grille, fog lights, front license plate, sensors) Hood & Windshield (Includes: bug deflector, wipers, front glass) Driver Side Body (Includes: front fender, doors, rocker panel, rear quarter panel) Passenger Side Body (Includes: front fender, doors, rocker panel, rear quarter panel) Side Mirrors (Includes: housing and mirror glass for both sides—high frequency damage) Roof & Top Accessories (Includes: antenna, shark fin, roof rack, rails, sunroof) Rear Bumper Assembly (Includes: exhaust tips, rear sensors, trailer hitch) Trunk / Hatch / Tailgate (Includes: spoiler, rear license plate, handle, latch) Rear Window & Wiper (Includes: rear glass and the rear wiper arm/blade) Wheels & Tires (Includes: rims, hubcaps, tires, mud flaps) Additional details about incident - please provide as much detail as possiblePlease let us know what's on your mind. Have a question for us? Ask away.
