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CUSTOMER INCIDENT REPORT
PART 1: TO BE COMPLETED BY EMPLOYEE
Employee Name
Wash-N-Shine Location Number
Date of incident mm/dd/yy
Date incident reported to you mm/dd/yy
Did you see incident actually happen?
Yes No
Comments

PART 2: TO BE COMPLETED BY CUSTOMER
Customer Name
Address
Telephone
Date of incident mm/dd/yy
Time incident occurred
In which bay did incident occur
VEHICLE INFORMATION
Make
Model
Year
Comments



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