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REPAIR
REFERRAL
VISIT
Phone
Phone
(718) 777-9277
(386) 880-5845
INSURED'S INFORMATION
VEHICLE INFORMATION
PUT "NO PLATE" IF YOU HAVE A TEMPOR
ARY
STATE
STYLE
EXTERIOR COLOR
INTERIOR SEAT
INTERIOR SEAT COLOR
2 DOOR
4 DOOR
CONVT.
ST. WAGN
HTCHBK.
VAN
SUV
MINIVAN
TRUCK
MOTORCYCLE
OTHER
ACCESSORIES & OPTIONAL EQUIPMENT
RADIO
*
Required
AM/FM
AM/FM/CASSETTE
CD PLAYER
CD CHANGER
AUTOMATIC TRANSMISSION
OVERDRIVE
AWD
4X4
MANUAL TRANSMISSION
3
4
5
6
SAFETY
*
Required
ANTI-LOCK BREAK
FRONT AIR BAGS
REAR AIR BAGS
SIDE AIR BAGS
SEATS
*
Required
AUTOMATIC SEAT BELTS
POWER SEATS
HEATED SEATS
LUMBAR
EXTERIOR
*
Required
CUSTOM/MAG WHEELS
SPECIAL HUB CAPS
SPECIAL TIRES
SPOILER
SUNROOF/MOONROOF
REAR WINDOW WIPER
DAYTIME RUNNING LIGHTS
BLIND SPOT DETECTION SYSTEM
BACKUP CAMERA
COLLISION AVOIDANCE SYSTEM
BACKUP SENSOR
INSTRUMENTATION
*
Required
AIR CONDITIONER
DIGITAL INSTRUMENTATION
CRUISE CONTROL
TILT WHEEL
POWER WINDOWS
POWER DOOR LOCKS
POWER STEERING
POWER ANTENNA
POWER TRUNK
POWER MIRRORS
FOR COMMERCIAL VANS & LIMOS ONLY
INTERIOR PANELING
INTERIOR RUGS
REAR PASSENGER SEATING
EXTERIOR DECORATIVE PAINT
CUSTOM WINDOWS OR BUBBLES
BEDS/COTS
STEREO
REFRIGERATOR
TELEVISION / VCR / DVD
SUBMIT
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