Vehicle Assessment

Use for vehicle inspection.

Vehicle Assessment

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Inspection Date & Time *

First Name *

Last Name *

Address

Address Line 1 *

Address Line 2

City *

State *

Zip *

Country *

License/Registration Number

Phone

VIN Number

Vehicle Year *

Vehicle Make

Vehicle Model

Vehicle Mileage

Front Bumper *

Back Bumper *

Leaks under vehicle *

Tire pressure *

Windows *

Doors *

Front/Back lights *

Side mirrors *

Clean interior *

Floor free of hazards *

Seat belts condition *

Mirrors *

Brake functionality *

Heat *

A/C *

Warning lights *

Under The Hood

Oil level *

Wiper fluid level *

Belts *

Hoses *

Brake fluid *

Power steering fluid *

Coolant level *

Electrical

Left turn signal *

Right turn signal *

High beams *

Low beams *

Emergency flashers *

Horn *

Windshield wipers *

Brake lights *

Safety Equipment

Reflective triangles or flares *

First aid kit *

Bio-hazard kit *

Seatbelt cutter *

Accessiblity Equipment (if applicable)

Cycle lift *

Proper number of seat belts *

Emergency handle *

Hydraulic fluid *

Notes Upload Relevant Images * Drag and drop image here or Upload upto 1 Images.Max File Size: MB

Signature

Inspector First Name

Inspector Last Name

<label> Inspection Date & Time *
    [date_time inspection_date_time "m/d/Y h:i A"] </label>


    
    <label> First Name *
        [text* first-name autocomplete:first-name] </label>
    
    
    <label> Last Name *
        [text* last-name autocomplete:last-name] </label>
    


<label>Address</label>
[address address-463 format:international required_fields:line1|city|state|zip|country]


    
    <label> Email
        [email mail] </label>
    
    
    <label> License/Registration Number
        [text* license-registration] </label>
    



    
    <label> Phone
        [phone phone] </label>
    
    
    <label> VIN Number
        [text vin-number] </label>
    



    
    <label> Vehicle Year *
        [text* vehicle-year] </label>
    
    
    <label> Vehicle Make
        [text vehicle-make] </label>
    



    
    <label> Vehicle Model
        [text* vehicle-model] </label>
    
    
    <label> Vehicle Mileage
        [text vehicle-mileage] </label>
    



    
    <label> Front Bumper *
        [select* front-bumper first_as_label "- select -" "Pass" "Fail"] </label>
    
    
    <label> Back Bumper *
        [select* back-bumper first_as_label "- select -" "Pass" "Fail"] </label>
    



    
    <label> Leaks under vehicle *
        [select* leaks-under-vehicle first_as_label "- select -" "Pass" "Fail"] </label>
    
    
    <label> Tire pressure *
        [select* tire-pressure first_as_label "- select -" "Pass" "Fail"] </label>
    



    
    <label> Windows *
        [select* windows first_as_label "- select -" "Pass" "Fail"] </label>
    
    
    <label> Doors *
        [select* doors first_as_label "- select -" "Pass" "Fail"] </label>
    



    
    <label> Front/Back lights *
        [select* front-back-lights first_as_label "- select -" "Pass" "Fail"] </label>
    
    
    <label> Side mirrors *
        [select* side-mirrors first_as_label "- select -" "Pass" "Fail"] </label>
    



    
    <label> Clean interior *
        [select* clean-interior first_as_label "- select -" "Pass" "Fail"] </label>
    
    
    <label> Floor free of hazards *
        [select* floor-fazards first_as_label "- select -" "Pass" "Fail"] </label>
    



    
    <label> Seat belts condition *
        [select* seat-belts-condition first_as_label "- select -" "Pass" "Fail"] </label>
    
    
    <label> Mirrors *
        [select* mirrors first_as_label "- select -" "Pass" "Fail"] </label>
    



    
    <label> Brake functionality *
        [select* brake-functionality first_as_label "- select -" "Pass" "Fail"] </label>
    
    
    <label> Heat *
        [select* heat first_as_label "- select -" "Pass" "Fail"] </label>
    



    
    <label> A/C *
        [select* ac first_as_label "- select -" "Pass" "Fail"] </label>
    
    
    <label> Warning lights *
        [select* warning-lights first_as_label "- select -" "Pass" "Fail"] </label>
    


[section_break section_break-876 "Under The Hood"]


    
    <label> Oil level *
        [select* oil_level first_as_label "- select -" "Pass" "Fail"] </label>
    
    
    <label> Wiper fluid level *
        [select* wiper-fluid-level first_as_label "- select -" "Pass" "Fail"] </label>
    



    
    <label> Belts *
        [select* belts first_as_label "- select -" "Pass" "Fail"] </label>
    
    
    <label> Hoses *
        [select* hoses first_as_label "- select -" "Pass" "Fail"] </label>
    



    
    <label> Brake fluid *
        [select* brake-fluid first_as_label "- select -" "Pass" "Fail"] </label>
    
    
    <label> Power steering fluid *
        [select* power-steering-fluid first_as_label "- select -" "Pass" "Fail"] </label>
    



    
    <label> Coolant level *
        [select* coolant-level first_as_label "- select -" "Pass" "Fail"] </label>
    
    
    


[section_break section_break-877 "Electrical"]


    
    <label> Left turn signal *
        [select* left-turn-signal first_as_label "- select -" "Pass" "Fail"] </label>
    
    
    <label> Right turn signal *
        [select* right-turn-signal first_as_label "- select -" "Pass" "Fail"] </label>
    



    
    <label> High beams *
        [select* high-beams first_as_label "- select -" "Pass" "Fail"] </label>
    
    
    <label> Low beams *
        [select* low-beams first_as_label "- select -" "Pass" "Fail"] </label>
    



    
    <label> Emergency flashers *
        [select* emergency-flashers first_as_label "- select -" "Pass" "Fail"] </label>
    
    
    <label> Horn *
        [select* horn first_as_label "- select -" "Pass" "Fail"] </label>
    



    
    <label> Windshield wipers *
        [select* windshield-wipers first_as_label "- select -" "Pass" "Fail"] </label>
    
    
    <label> Brake lights *
        [select* brake-lights first_as_label "- select -" "Pass" "Fail"] </label>
    


[section_break section_break-659 "Safety Equipment"]


    
    <label> Reflective triangles or flares *
        [select* reflective-triangles first_as_label "- select -" "Pass" "Fail"] </label>
    
    
    <label> First aid kit *
        [select* first-aid-kit first_as_label "- select -" "Pass" "Fail"] </label>
    



    
    <label> Bio-hazard kit *
        [select* bio-hazard-kit first_as_label "- select -" "Pass" "Fail"] </label>
    
    
    <label> Seatbelt cutter *
        [select* seatbelt-cutter first_as_label "- select -" "Pass" "Fail"] </label>
    


[section_break section_break-188 "Accessiblity Equipment (if applicable)"]


    
    <label> Cycle lift *
        [select* cycle-lift first_as_label "- select -" "Pass" "Fail"] </label>
    
    
    <label> Proper number of seat belts *
        [select* proper-number-seat-belts first_as_label "- select -" "Pass" "Fail"] </label>
    



    
    <label> Emergency handle *
        [select* emergency-handle first_as_label "- select -" "Pass" "Fail"] </label>
    
    
    <label> Hydraulic fluid *
        [select* hydraulic-fluid first_as_label "- select -" "Pass" "Fail"] </label>
    


<label> Notes
    [textarea notes x3] </label>

<label> Upload Relevant Images *
    [image_upload* image_upload-343 max_files:1] </label>

[section_break section_break-366 "Signature"]


    
    <label> Inspector First Name
        [text inspector-first-name] </label>
    
    
    <label> Inspector Last Name
        [text inspector-last-name] </label>
    


[submit "Submit"]

Input Fields Used in this Template

Explore the advanced functionalities that extend Contact Form 7, enhancing your form capabilities and optimizing user interactions

Date Time Field

Text Field

Address Field

Email field

Phone Field

Dropdown select

Section Break Field

Textarea field

Image Upload Field

Submit button

Feature of this Template

Here is a quick overview of the features of this template, highlighting its key functions and how they can help you automate your process.

Vehicle Information: Collects details about the vehicle, including make, model, year, and VIN (Vehicle Identification Number).
Mileage: Records the current mileage of the vehicle.
Exterior Condition: Assesses the condition of the vehicle’s exterior, including any dents, scratches, or paint issues.
Interior Condition: Evaluates the state of the interior, including seats, dashboard, and upholstery.
Mechanical Condition: Reviews the performance of key mechanical systems such as the engine, transmission, and brakes.
Maintenance and Service History: Requests details on any past maintenance or repairs performed on the vehicle.