Car Damage Panel Required For Claims Process

[ghost]

We need a small Java Applet, JQuery type gadget which can be embedded in a HTML page.

The idea is as we build out the new claims process we need a way to describe damage to a vehicle.

Will be used in a form.

Make
Model
Registration
Location

Front Damage % Damage
LH Side Damage % Damage
RH Side Damage % Damage
Rear Damage % Damage

Garage Name
Garage Address
Garage Contact No.
Repair Price £ xxx.xx
Special Conditions.
Availability