Intake Form Free | Rocketpros Lite

Comments

This field is for validation purposes and should be left unchanged.

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Sponsored By:

Shop Admin Email(Required)

Input Shop Email To Receive This Form

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This field is required.

Shop Name(Required)

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This field is required.

Customer Name(Required)

First Last

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This field is required.

What Type Of Estimate Is Required?

MPIC Physical Damage Claim

MPIC Glass Claim

Non MPIC Related Work

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Is Your Vehicle Driveable?

Yes

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Claim is Reported, Customer has Claim # and License Plate of Vehicle?

Yes

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Has MPI already looked at your vehicle?

Has MPI performed an estimate on this vehicle?

Yes

Direct Repair

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When was/is your estimate appointment date with MPIC?

If customer cannot give you this date, don’t worry about it and we can move on to the next question.

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Missing Information

Direct Customer to call back once they have reported their claim to MPIC and have a claim number and a license plate number for us to use.

Open A Glass Claim

Would you like to go to the Mitchell Cloud Glass Platform? Mitchell Cloud Glass Login

Vehicle Details(Required)

Year Make Model License Plate

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This field is required.

Claim Number

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Mobile Phone

The preferred phone number to capture

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Consent Required | Can we send you text messages about updates to your repairs?

Yes

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Alternate Phone

If not a mobile phone

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Customer Email

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Comments / Statement

How and where did the accident/loss happen?

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Did the animal go under the vehicle?

Yes

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Are there still keys available with the vehicle?

Yes

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Secondary Impact Area?

Often the customer forgets that the vehicle had a secondary impact. A common occurrence is after a collision is the opposite side of the vehicle strikes a curb.

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In the Owners Opinion is the Vehicle is Safe to Drive?

Yes

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Description of Unsafe Items

What does the customer feel is unsafe about their vehicle, we will work to address this faster.

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Is your vehicle for personal use or commercial use?

Does the customer write off this vehicle for tax purposes under any corporation?

Personal

Commercial

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Percentage of Taxes Claimed Back on This Vehicle

If customer is unsure, they need to talk to their accountant and obtain accurate information.

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Does insured carry any additional coverage?

This is SMI, or sandbox or other additional policies. Generally what people will do is purchase the basic insurance from MPI, then get additional insurance from one of these insurance companies that lowers there deductible and adds coverage for rental vehicles etc.

Yes

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Policy Name

This will be the company name of the policy, i.e. SMI, SRE, Sandbox, Etc. Not the brokers name that they purchased from.

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Additional Policy Number

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Broker Where Policy Was Purchased

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Replacement Vehicle Required During Repairs?

Explain Shops Rental Policy

Yes