Name:
If Your Vehicle Is Not
Here, What Time &
Date Will You Bring It?
Email address:
Home or Cell Number:
Work Phone number:
City:
Address:
Zip Code:
Your Insurance Co.:
Ins. Co. Paying For Claim:
Claim Number, If
Known:
Year Of Car:
Type Of Car:
Date Of Loss:
Color Of Car:
Were you referred to
us? If so, who?
Do you plan to have us
repair your vehicle?
Do you plan to have
your vehicle
repaired?
What part of your
vehicle is damaged?
Any Comments?
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about us?
Hit Submit When
Form Is Completed.
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Phone: 214-637-2468

Fax: 214-637-7779
Marty Logan's House of Colour
2310 Jim Street
Dallas, TX 75212