Appointment

Appointment Form & Customer Information

Don Beck Locations	*required

Customer Information
Registered Owner's Name	*required
Contact Name	*required
Address
Email Address
Home Phone #	*required
Work Phone #
Fax #

Vehicle Information
Make of Vehicle	*required
Vehicle Model
License Number	*required

Transportation
Are you insured for loss of use?	Yes No*required
Are you presently in a rental car?	Yes No*required
Do you require alternate transportation (Courtesy Car)?	Yes No*required

Insurance Information
*I.C.B.C. Claims*
Claim Centre Attended	*required
I.C.B.C. Claim #	*required
Are you an I.C.B.C. Gold Class Customer?	Yes No*required
Are you an I.C.B.C. Road Star Customer?	Yes No*required

Private Insurance Claims (other than I.C.B.C.)
Insurance Company	*required
Private Insurance Claim #	*required
Adjuster

Don Beck Collision Services
Toll Free in B.C.: 1-877-787-2488
Email: info@donbeck.com