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Incident Report
GN-Incident Claim
Incident Report
Please provide detailed information regarding any incidents you are claiming happened during your visit to the car wash. We are sorry but we assume no responsibility for the following: Loose molding, pre-existing damage, and aftermarket equipment.
Location
(Required)
Select Store Location
Enfield, CT - 109 Elm St.
Hartford, CT - 30 Kane Street
Hartford, CT - 140 Weston St.
Manchester, CT - 344 Broad Street
Norwich, CT - 684 W. Main St
Rocky Hill, CT - 623 Cromwell Avenue
West Hartford, CT - 22 South Street
Auburn, MA - 310 Washington St.
Chicopee, MA - 520 Montgomery St.
Chicopee, MA - 467 Memorial Dr
Danvers, MA - 149 Endicott St.
East Longmeadow, MA - 204 North Main Street
Easthampton, MA - 124 Northampton Street
Gardner, MA - 6 Pearson Blvd
Greenfield, MA - 58 Newton Street
Hadley, MA - 456 Russell Road
Ludlow, MA - 425 Center Street
Lynnway, MA - 535 Lynnway
Milford, MA - 39 Green St
Northampton, MA - 492 Pleasant St. #4
Oxford, MA - 138 Southbridge St.
Pittsfield, MA - 1050 South Street
Springfield, MA - 915 East Columbus Avenue
Springfield, MA - 1315 Boston Road
W. Boylston, MA - 257 W. Boylston St.
Wakefield, MA - 590 Main St.
West Springfield, MA - 2685 Westfield Street
West Springfield, MA - 518 Memorial Avenue
Westborough, MA - 126 Turnpike Rd
Westfield, MA - 88-90 South Maple St.
Wilbraham, MA - 2810 Boston Rd.
Wilmington, MA - 220 Main St.
Worcester, MA - 340 Grove St.
Worcester, MA - 466 Lincoln St.
Auburn, ME - 828 Minot Ave.
Bangor, ME - 729 Broadway Street
Lewiston, ME - 1103 Lisbon St.
Lewiston, ME - 449 Sabattus St.
Manchester, ME - 865 Western Ave
Norway, ME - 46 Main Street
Old Orchard Beach, ME - 215 Saco Ave
Sanford, ME - 1439 Main St.
Scarborough, ME - 284 Payne Rd
Thomaston, ME - 160 New County Rd.
Waterville, ME - 340 Kennedy Memorial Dr.
Wiscasset, ME - 695 US Rt 1 (Bath Rd)
Concord, NH - 24 Loudon Rd
Concord, NH - 165 Loudon Rd
Dover, NH - 1 Long Hill Rd.
Exeter, NH - 158 Epping Rd.
Hooksett, NH - 1326 Hooksett Rd.
Goffstown, NH - 100 Mast Rd
Londonderry, NH - 12-14 Nashua Rd
Manchester, NH - 1932 S. Willow St.
Nashua, NH - 620 Amherst St.
Nashua, NH - 7 Harris Rd.
Nashua, NH - 86 Broad St.
Rochester, NH - 130 Washington St.
Cumberland, RI - 4120 Mendon Rd
Golden Nozzle - Worcester Corporate
Date & Time claimed incident happened
(Required)
MM slash DD slash YYYY
Claims must be reported within 48 hours of the incident.
Time the incident occurred
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Name of person who was driving the vehicle
(Required)
First
Last
Address of the person who was driving the vehicle
(Required)
Street Address
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone Number
(Required)
Customer email address
(Required)
Check the "Yes" box if you would like to add an additional email:
Yes
Additional customer email address
(Required)
If you're an unlimited wash pass member, please enter your pass # here:
Vehicle Make
(Required)
Vehicle Model
(Required)
Vehicle Color
(Required)
Vehicle Year
(Required)
Vehicle License Plate #
(Required)
State
(Required)
Select State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Was the car wash damaged in this incident?
No
Yes
Was contact made with any other vehicles inside of the car wash?
No
Yes
First and last name of the driver of the other vehicle
First
Last
What are you (as the customer) claiming happened at the car wash?
Please upload photos of the claimed damage:
Drop files here or
Select files
Max. file size: 15 MB.
IF YOU DO NOT HEAR FROM ANYONE IN 3-5 BUSINESS DAYS, PLEASE CALL
413-642-9139