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__________________
______________________________________________
______________________________________________
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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_________________________________
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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:
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
Baker Paint & Body Shop
1950 E. Walnut St.
Pasadena, CA 91107
(626)793-7463
E-mail - ron-jr@bakerpaintandbody.com
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