Code Customs Collision Intake

Need collision repair? Start your repair process with Code Customs. Complete the form below and our team will review your information and contact you regarding the next steps.

Customer Information

First name

Last name

Phone number

Email address

Vehicle & Collision Information

Vehicle (year, make, and model) & VIN

Date of accident/loss

Damage description

Insurance Claim Information

Will this repair involve an insurance claim?

Yes

Not sure yet

Authorization & Acknowledgment

Submitting this form does not authorize repairs or guarantee insurance coverage or payment. A Code Customs representative will contact you to discuss the next steps and any required repair authorization.

I certify that the information submitted is accurate to the best of my knowledge.

I authorize Code Customs to contact me by phone, text, or email regarding my vehicle, collision repair, estimate, insurance claim, and appointment.