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Run: Secondary Supplement Request Form

Use this Secondary Supplement Request Form to document newly discovered damage, list added parts and labor, and capture renewed approval before repair work c...

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Submission Details

Repair Order Number (required)

Enter the internal repair order or RO number for this vehicle.

Claim Number (required)

Enter the insurer claim number if available.

Supplement Request Date (required)

Date the secondary supplement is being requested.

Estimator Name (required)

Name of the estimator submitting the request.

Estimator Email (required)

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 (required)

Model year of the vehicle.

Vehicle Make (required)

Manufacturer of the vehicle.

Vehicle Model (required)

Model of the vehicle.

VIN Last 8 Characters (required)

Enter only the last 8 characters of the VIN to support identification while minimizing PII.

Repair Stage When Additional Damage Was Found (required)

Select the stage of repair when the additional items were discovered.

How Was the Additional Damage Discovered? (required)

Choose the method used to identify the new damage or parts need.

Additional Damage and Parts

Summary of Additional Damage (required)

Describe the newly discovered damage, missing parts, or hidden repair needs.

Affected Systems or Areas (required)

Select all areas affected by the newly discovered damage.

Additional Parts Needed (required)

List each additional part required for the supplement request.

Additional Labor Hours (required)

Total additional labor hours requested for the supplement.

Sublet or Specialty Work Required? (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 (required)

Select who must approve the secondary supplement.

Current Authorization Status (required)

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 (required)

Sign to confirm the supplement request is accurate to the best of your knowledge.

Acknowledgment (required)

Confirm that newly discovered work will not proceed until the required authorization is received.

Yes No N/A

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