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Auto Accident Guide
July 20, 2012
Agency

Auto Accident Guide

Knowing what to do after an accident will help you to remain calm and in control.  It may even make the experience a little less frightening.  Take a moment to review this guide, print it and keep it in the glove compartment of your vehicle so that you can use it in the event of an accident.

Your Information
Name:_______________________________Date:_____________Time:_________City:_________State:_______

Phone#:______________________________Email:__________________________________________________

Intersection or address where accident occurred:_____________________________________________________

Road Condition:_______________________________Weather:_________________________________________

What direction you were going:_________ Speed: _______Speed Limit:_______Police Dept:__________________

Police Report #:_______________   Accident Description:______________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Your Vehicle Year ________ Make_________Model_________Plate__________VIN#_________________________

Damage to YOUR Vehicle:________________________________________________________________________

Driver of Your Vehicle:_____________________Phone #_____________________ 

Other Driver’s Information:
Owners Name:______________________ Phone#:____________________Email:__________________________

Address:_________________________City:________________State:___________________Zip:_____________

Insurance Company:_______________________________Policy#:____________Effective Dates:______________

Drivers Name:_________________________Phone #:______________________Birthday:___________________

Drivers License #:_____________________  Year:_________Make:_________Model:_______________________

VIN#:_________________________________ Plate#:_____________________ Damage to Other Vehicle:______

___________________________ 

Injured Parties:  List names, addresses, phone numbers and which vehicle they were in.  Also list type of injuries

known. _____________________________________________________________________________________________

Witnesses: List names, addresses, phone numbers, which vehicle they were in or if they were independent

witnesses to the accident:________________________________________________________________________

CALL BERNARD E. PEDERSEN INSURANCE AGENCY IN PALATINE IL. AT 847-359-6070 IF YOU HAVE QUESTIONS

REGARDING YOUR CLAIM.  YOUR INSURANCE COMPANY’S CLAIMS PHONE NUMBER IS LISTED ON YOUR AUTO

INSURANCE ID CARD LOCATED IN THE GLOVE COMPARTMENT OF YOUR VEHICLE.  IF YOU DO NOT HAVE A

CURRENT AUTO INSURANCE ID CARD PLEASE CALL US OR EMAIL US TODAY!! 
http://www.bepinsurance.com/

Safe driving to one and all and don’t forget to buckle up!  It’s the law!!

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