When you are involved in an accident events can be confusing and important information can be overlooked. That is why we made it simple for you to record vital details of the accident. You can print the accident form in the tools and resources section. If you have further questions please contact us.

Read This First

If you have an accident follow these simple steps to speed up the processing of your claim. The more information we have, the faster and more fairly and more fairly we can settle your claim.

• Call the Police

• Stay at the scene

• Do not discuss the accident with anyone but the the Police at the scene.

• Do not discuss detail of your insurance coverage or your policy limits.

• Get a Police Report Number if possible.

• Write down the names, addresses and phone numbers of others involved in the accident and witnesses.

• Write down the license numbers and insurance company names and policy numbers of everyone involved in the accident.

Accident Notes

Use the form to record your own recollection of the accident as soon as you can, while details are still fresh in your memory. Write the date and time of the accident and the weather and road conditions. Write down all details you can think of even if they do not seem important to you. IMPORTANT – If you have a camera or a Cell Phone with picture capability take some shots of the scene, vehicle damage etc.

Accident Information Form – Witnesses

Please complete as much of the following information as possible.

• Did you see the accident?

• Were you involved in the accident?

• Describe the accident.

• Did anyone appear to be hurt?

• Who, if anyone, do you feel was responsible?

• Your Name

• Your Address

• Your Phone Numbers at home and work

Accident Information Form – Other Driver

Your Information that is needed.

• Name

• Address

• Home Address

• Work Phone

• Driver’s License #

• Insurance Agent

• Insurance Company

• Insurance Policy #

• Are you injured?

Passengers Information that is needed.

• Name

• Address

• Phone#

• Are you injured?