PLEASE PRINT OUT THIS PAGE AND KEEP IT IN YOUR VEHICLE.

COMPLIMENTS OF A&R AUTOBODY

General Information

Date:___________

Time:___________

Weather & Road Conditions:__________________________________________________

Accident Location:_____________________________________________

Anyone Injured:___________________________________________

Damaged area of other vehicle:__________________________________

Witness name and Phone:________________________________________

Police officer name:_____________________________

Badge #:___________________

Case #:___________________

Other:__________________________________

Other Persons Information

Name:___________________________________________

Address:______________________________________________________

Phone #: Home__________________ Work_____________________

License #:___________________________

Plate #:_______________________________

Color of Car:___________________________

Year, Make and Model:____________________________________________

Insurance Co.:_______________________________________________

Policy #:______________________________

Other:__________________________________________________________

Accident Details

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

This form is for notes only.

Do's and Dont's are suggestions only. Please contact your Collision Shop for specifics.