Accident Information Form Print out this page. Fill out the bottom part of this form, then carry this (and a pencil) in your car. If you get in an accident, tear off the bottom to give the other driver, and then fill out as much information as you can. Some of this information may never be recovered if you don't get it at the time of the accident, so give it your best shot. Remember: DON'T PANIC! Fill This In at the Scene (If you can) Date Time Location of accident Opposing Party: Name Driver's License No. License Plate Car Description Insurance Company Policy Number Witness Name Phone Number Witness Name Phone Number Police Officer Name Badge or ID Number Police Report Number Towing Company Phone Number

Get medical help if needed. In case of an emergency where we can help, our number is 509-326-6935.