Accident Information Form
Compliments of:
Advanced Auto Body
at: The Restoration Center
53-63 Main Street
Athol, MA 01331
(978) 249-9255
Print this form out and fill in the information in case of accident.
Your Insurance Company
Your Policy #
Your Agent
Date of Accident
Time of Accident
Location
Other Driver's Name
Address
City
State
Zip
Phone #
Yr, Make, Model of Vehicle
License #
Driver's License #
(Include State of Issue)
Insurance Company
Agent
Policy #
Witness 1
Name
Phone
Address
City
State
Zip
Witness 2
Name
Phone
Address
City
State
Zip
Please keep this in your glove box. Fill out and exchange information in case of accident.