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Owner ID

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Owner Company

Insurance Company(Required)

Claim Number / Reference(Required)

Claim Amount(Required)

Supplement Amount

Notes / Description

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Our Services

Door Ding, or Minor Dent Repair
Hail Dent Repair
Commercial Paintless Dent Repair
$0 Deductible

Service Areas

Lafayette
Breaux Bridge
Youngsville
Broussard
Milton
Rayne
Crowley
Scott
Abbeville
Carencro
Duson

Our Services

Lafayette, La 70503

(225) 288-4222‬

info@norse-pdr.com

Monday - Friday: 8:30 am - 5:30 pm
Saturday & Sunday: Appt. Only

Our Location

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Quote Form

Step 1 of 11

0%

Select Damage Type(Required)

Hail Damage

Door Ding

Other

Select Vehicle Type

Car

Truck

SUV

Van

Hybrid

Other

Other Type

Select Damaged Panel Location

Front

Right Side Front Panel

Right Side Back Panel

Left Side Front Panel

Left Side Back Panel

Top

Back

Select Damaged Panel Location

Hood

Right Side Front Panel

Right Side Back Panel

Left Side Front Panel

Left Side Back Panel

Roof

Back

Select Damaged Panel Location

Hood

Right Side Front Panel

Right Side Back Panel

Left Side Front Panel

Left Side Back Panel

Roof

Back

Select Damaged Panel Location

Hood

Right Side Front Panel

Right Side Back Panel

Left Side Front Panel

Left Side Back Panel

Roof

Back

Select Damaged Panel Location

Hood

Right Side Front Panel

Right Side Back Panel

Left Side Front Panel

Left Side Back Panel

Roof

Back

Select Damaged Panel Location

Hood

Right Side Front Panel

Right Side Back Panel

Left Side Front Panel

Left Side Back Panel

Roof

Back

Top/Roof Dent Report

Select Size of Dent(s)(Required)

0.7" (Dime Size)

0.83" (Nickel Size)

1.0" (Quarter Size)

1.25" (Half Dollar Size)

Select Number of Dents on Panel(Required)

Very Light (1-5 Dents)

Light (6-15 Dents)

Moderate (16-30 Dents)

Medium (31-50 Dents)

Heavy (51-75 Dents)

Severe (76-100 Dents)

Extreme (101-150 Dents)

Front/Hood Dent Report

Select Size of Dent(s)(Required)

0.7" (Dime Size)

0.83" (Nickel Size)

1.0" (Quarter Size)

1.25" (Half Dollar Size)

Select Number of Dents on Panel(Required)

Very Light (1-5 Dents)

Light (6-15 Dents)

Moderate (16-30 Dents)

Medium (31-50 Dents)

Heavy (51-75 Dents)

Severe (76-100 Dents)

Extreme (101-150 Dents)

Back/Trunk Dent Report

Select Size of Dent(s)(Required)

0.7" (Dime Size)

0.83" (Nickel Size)

1.0" (Quarter Size)

1.25" (Half Dollar Size)

Select Number of Dents on Panel(Required)

Very Light (1-5 Dents)

Light (6-15 Dents)

Moderate (16-30 Dents)

Medium (31-50 Dents)

Heavy (51-75 Dents)

Severe (76-100 Dents)

Extreme (101-150 Dents)

Right Front Dent Report

Select Size of Dent(s)(Required)

0.7" (Dime Size)

0.83" (Nickel Size)

1.0" (Quarter Size)

1.25" (Half Dollar Size)

Select Number of Dents on Panel(Required)

Very Light (1-5 Dents)

Light (6-15 Dents)

Moderate (16-30 Dents)

Medium (31-50 Dents)

Heavy (51-75 Dents)

Severe (76-100 Dents)

Extreme (101-150 Dents)

Right Rear Dent Report

Select Size of Dent(s)(Required)

0.7" (Dime Size)

0.83" (Nickel Size)

1.0" (Quarter Size)

1.25" (Half Dollar Size)

Select Number of Dents on Panel(Required)

Very Light (1-5 Dents)

Light (6-15 Dents)

Moderate (16-30 Dents)

Medium (31-50 Dents)

Heavy (51-75 Dents)

Severe (76-100 Dents)

Extreme (101-150 Dents)

Left Front Dent Report

Select Size of Dent(s)(Required)

0.7" (Dime Size)

0.83" (Nickel Size)

1.0" (Quarter Size)

1.25" (Half Dollar Size)

Select Number of Dents on Panel(Required)

Very Light (1-5 Dents)

Light (6-15 Dents)

Moderate (16-30 Dents)

Medium (31-50 Dents)

Heavy (51-75 Dents)

Severe (76-100 Dents)

Extreme (101-150 Dents)

Left Rear Dent Report

Select Size of Dent(s)(Required)

0.7" (Dime Size)

0.83" (Nickel Size)

1.0" (Quarter Size)

1.25" (Half Dollar Size)

Select Number of Dents on Panel(Required)

Very Light (1-5 Dents)

Light (6-15 Dents)

Moderate (16-30 Dents)

Medium (31-50 Dents)

Heavy (51-75 Dents)

Severe (76-100 Dents)

Extreme (101-150 Dents)

Name(Required)

First Last

Phone(Required)

Email Address(Required)

Zip Code(Required)

Vehicle Make(Required)

Vehicle Year(Required)

Model(Required)

Vehicle Make(Required)

Vehicle Model(Required)

Upload Images

Drop files here or

Accepted file types: jpg, jpeg, png, gif, heic, Max. file size: 50 MB.

If Applicable, Upload Claim Document

Accepted file types: jpg, jpeg, pdf, doc, docx, Max. file size: 50 MB.

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