Vehicle Incident Report | Spark Car Wash

📋 Report Information

Report Type

Vehicle Incident Report

Location *

Your Name *

Position

General Manager

—

District Manager

—

Date Incident Reported

Time Reported

Date of Incident *

Time of Incident *

👤 Customer Information

Customer Name *

USC Member? *

Customer Email *All correspondence sent via email throughout the process.

Customer Phone *

Customer Address *

City *

State *

Zip *

🚗 Vehicle Information

Year *

Make *

Model *

Color *

License Plate *

VIN *Door jamb, windshield, insurance card, or registration.

📝 Claim Information

Problem Description *

Problem Location *

Customer Description of Events *

📷 Required Photos

All six photos are required. They will be embedded directly into the submitted PDF report.

License Plate *

📷

Upload or drag here

Clear photo of the plate

VIN Sticker *

📷

Upload or drag here

Door jamb, windshield, insurance card, or registration

Damage - Close, Straight On *

📷

Upload or drag here

1-2 ft away, straight on

Damage - Wide, Straight On *

📷

Upload or drag here

5-10 ft away, straight on

Damage - Close, At an Angle *

📷

Upload or drag here

1-2 ft away, at an angle

Damage - Wide, At an Angle *

📷

Upload or drag here

5-10 ft away, at an angle

✍ Disclaimer & Signature

By signing this report, both parties acknowledge that the information provided is true and accurate. All vehicle damage claims are submitted directly to Spark Car Wash's insurance carrier for review. Once this report has been submitted, customers will be contacted by our insurance carrier regarding next steps. Please do not contact Spark Car Wash team members directly to discuss the status of your claim. This report does not constitute an admission of responsibility by Spark Car Wash, nor does the customer's signature release Spark Car Wash from any liability.

I have read and understand the terms of the disclosure.

Customer Signature *

Spark Car Wash

Report Submitted