Collision Repair Appointment Request

Contact Information

* First Name: * Last Name:
* Email: Day Phone:
Address:
City: State: * ZIP Code:
Survey Questions

Please Enter Year, Make, Model, Miles and VIN of your vehicle:

Vehicle Damage Information (Define below if other):

Roof Grill Hood Trunk Bumper Left Rear Fender Left Front Door Left Rear Door Right Front Door Left Front Fender Right Front Fender Right Rear Fender

Vehicle Glass Damage Information (Define Below if other):

Windshield Rear Glass Left Front Door Glass Left Rear Door Glass Right Front Door Glass Right Rear Door Glass

Payment/Liability Information:

If an Insurance Company will be paying for the repairs please provide the Insurance Co. Name:

Towing Requirements (if towing is already handled, please state name of company in comment field below:

* These fields are required

Perry Auto Group – Your Norfolk and Elizabeth City Chevrolet, Chrysler, Dodge, and Jeep Dealer.
Perry Auto Group
P.O. Box 1607
Elizabeth City, NC 27909
Phone: (800) 897-3779
Email: Contact Us
Fax: (252) 335-4066
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Performance Chevrolet
1005 W Ehringhaus
Elizabeth City, NC 27909
Phone: (800) 897-3779
Fax: (252) 335-4066
Carolina Chrysler Dodge Jeep
1001 Halstead Blvd.
Elizabeth City, NC 27909
Phone: (800) 897-3779
Fax: (252) 338-1726