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Why CARSTAR?
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Roth & Miller CARSTAR
9255 SE Stark Street
  Portland OR 97216 ( Map )
Phone Number
503-257-9255
Hours
 Mon-Fri 8 a.m. to 5 p.m.
after hours by appointment
E-Mail Us


 

 




  SCHEDULE YOUR APPOINTMENT

Providing as much of the following information now will save you time when you come in for your estimate. Your personal information will not be sold, traded, leased or otherwise mistreated. We look forward to helping you with your Autobody repair needs!

Customer Information:
Name :
Date :
Address :
City :
State :
Zip :
Home Number :
Work Number :
Cell Number :
Fax :
E-Mail Address :
   
Vehicle Information:
Year :
Make :
 ( Ford, Chevrolet, etc. )
Model :
 ( Explorer, Impala, etc. )
Style :
 ( Van, Pickup, 2-door, etc. )
   
Important Information:
Who will be responsible for your repairs?
 My insurance Their insurance Other
If Other, please provide more information
Has the insurance company
written an estimate?
 Yes No
Claim Number :
Name of your insurance company
Deductible

Name of your insurance agent
Date of loss
Name of other party’s
insurance company
Is this your
 1st 2nd 3rd estimate?
Would you like us to repair your vehicle?
 Yes No

Will you require a rental car during the repairs?

 Yes No
Do you have any special concerns?
   
How Did You Find Out About Our Company?
 
Please check all that apply:
   
Repeat Customer Dealer Referral Yellow Page Billboard
Customer Referral Agent Referral TV Ad Radio
Insurance Co. Referral Business Referral Location Web Site
     
Other :
 
If you were referred to us, would you please give us their name
and address so that we may send them a thank you?
Referred by :

Address/City/State/Zip :