Get these facts in case of accident

Date________________Time_______________________

Location_________________ City___________________
Weather condition_____________________

Other drivers name_______________________________
Address________________________________________
Drivers license #_________________________________
Vehicle license #_________________ State___________
Phone number___________________________________

Insurance Co.___________________________________
Insurance policy_________________________________
Description of damage to other car__________________
______________________________________________
______________________________________________

diagram.gif (50012 bytes)

Witnesses Names

Officer present__________________________________

Witness name_____________Phone___________
Address________________________________________

Witness name_____________Phone___________
Address________________________________________

Witness name_____________Phone___________
Address________________________________________

List of Injured

Injured name______________Phone___________
Address________________________________________
Nature of injuries_________________________________

Injured name______________Phone___________
Address________________________________________
Nature of injuries_________________________________

Injured name______________Phone___________
Address________________________________________
Nature of injuries_________________________________

Draw diagram of accident showing the direction of both cars and the point of accident.  Show Street names and location of street signs (stop signs, etc.)

Describe any other damage or pertinent details below:
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________

 

JR's Paint & Body Shop
Junior Sims, Owner
5933 Graham Lane
Milton, Florida  32583
(850)626-6600

E-mail - Junior@JRsPaintAndBody.com