Solo Accident

Report Damage - solo accident

For damages that only involve your own car, please use this form. Feel free to take a picture of the damage and the accident location and have it available. This is information we may request later in the process.

License plate number*

First Name*

Last Name*

Email*

Telephone number*

Location of damage

Date of damage

Open calendar

Time

Description of the accident

Describe the extent of the damage to the car

Speed during the accident

Was a tow truck requested?

Was the police present?

Were there any witness(es) to the accident?

Can you provide us with the name and phone number of the witness(es)?

What could you have done to avoid the damage?

Was the driver under the influence of alcohol/drugs?

Are there any injuries?

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