NOTE: A Copy of your Quotation must be submitted together with this Subaru request! SUBARU

Save-a-Subaru Proposal Request

Fields with * indicate mandatory information. Please complete All fields in order to submit.

Panelbeater
Company Name *
Contact Person *
E-Mail Address *

Customer information
Customer Name *
Contact E-mail *
Address *
Servicing Dealer *

Vehicle information
Vehicle Model *
Vehicle Reg. No. *
Vehicle VIN No. *
Current Kilometres *
Vehicle Value *
Write-Off Threshold *
Estimated Vehicle Repair Total (Incl. VAT) *

Dealership
Dealership Province *
Subaru Dealership *
Dealer Code
Dealer Parts Manager *
Manager E-Mail Address *
Dealer Contact Person (if different to above) *
Dealer E-Mail Address *

Insurance Company
Insurance Company Used *
Insurance E-Mail Address *
Assessor's Name *
Assessor E-mail address *

Additional information

NOTE: A Copy of your Quotation must be submitted together with this Subaru proposal!
NOTE: All parts listed must correspond to your quotation to the Insurance Company

PART CODE* QUOTED PRICE* DEALER PRICE*