New Customer Intake Form

(If YES, please email us your company's Resale Certificate or Tax Exemption Certificate)

Contact information for estimate:

Yes, I consent to receive real-time updates and share collision pictures and messages with CMD Box Truck Repair & Collision. Message and data rates may apply; messaging frequency may vary. Reply STOP to end.

Contact information for Final invoice: (Please provide Accounts payable department contact information if applicable)

Contact information for Final invoice: (Please provide Accounts payable department contact information if applicable)

Please note their is a convenience fee of 3.1% for credit card transactions.
If your company does not utilize truck identification numbers, kindly indicate NA.
If VIN # not available, please provide License Plate # instead.
If YES, please provide the require information below. IMPORTANT: If you do not promptly inform us that the repair is an insurance claim, if may result in delays to both the estimate and the repair process.
Applicable only to Fleet companies.

If YES, please provide the required information below. If you do NOT promptly inform us that the repair is an insurance claim, it may result in delays to both the estimate and the repair process.