Secondary Supplement Request Form

Form for collision repair estimators to document additional damage or parts discovered during repair, request a secondary supplement, and capture renewed authorization before continuing work.

Submission Details

• Repair Order Number
  Enter the internal repair order or RO number for this vehicle.
• Claim Number
  Enter the insurer claim number if available.
• Supplement Request Date
  Date the secondary supplement is being requested.
• Estimator Name
  Name of the estimator submitting the request.
• Estimator Email
  Email address for follow-up questions and approval updates.
• Submission Notes
  Optional brief note about why the supplement is being submitted now.

Vehicle and Repair Information

• Vehicle Year
  Model year of the vehicle.
• Vehicle Make
  Manufacturer of the vehicle.
• Vehicle Model
  Model of the vehicle.
• VIN Last 8 Characters
  Enter only the last 8 characters of the VIN to support identification while minimizing PII.
• Repair Stage When Additional Damage Was Found
  Select the stage of repair when the additional items were discovered.
• How Was the Additional Damage Discovered?
  Choose the method used to identify the new damage or parts need.

Additional Damage and Parts

• Summary of Additional Damage
  Describe the newly discovered damage, missing parts, or hidden repair needs.
• Affected Systems or Areas
  Select all areas affected by the newly discovered damage.
• Additional Parts Needed
  List each additional part required for the supplement request.
• Additional Labor Hours
  Total additional labor hours requested for the supplement.
• Sublet or Specialty Work Required?
  Indicate whether outside or specialty work is needed.
• Sublet or Specialty Work Details
  Describe any sublet, calibration, alignment, diagnostic, or specialty work needed.
• Supporting Photos
  Upload photos that show the additional damage or removed parts.

Authorization and Review

• Authorization Requested From
  Select who must approve the secondary supplement.
• Current Authorization Status
  Indicate whether authorization has been received.
• Approver or Contact Name
  Name of the person who approved or is reviewing the supplement.
• Authorization Reference Number
  Enter the approval reference, claim note, or authorization code if provided.
• Estimator Signature
  Sign to confirm the supplement request is accurate to the best of your knowledge.
• Acknowledgment
  Confirm that newly discovered work will not proceed until the required authorization is received.