Will this fit my truck if the original has a camera hole?

No — this molding is cut without the camera opening. If your truck came with a factory backup camera, you'll want the camera-compatible version instead.

Do I need fasteners or adhesive to install this?

Mounting method isn't detailed in the product specs — test-fit first to confirm whether it uses factory clips, bolts, or adhesive before committing to installation.

Does this need paint or prep before installation?

The finish condition isn't specified — inspect the molding when it arrives and determine whether you need to sand, prime, or paint to match your truck's tailgate.