ACCIDENT AND DAMAGE FORM

If any accident and/or damage occurs to the vehicle during your rental period, you must submit an accident & damage report as soon as possible by filling out the form below.
Fields marked with an asterisk (*) are required.

Renter's First Name*

Renter's Last Name*

Contract No*

Renter's Address*

Additional Renter's First Name*

Additional Renter's Last Name*

Date and Time of Incident*

Location of Incident*

Vehicle Make and Model*

Vehicle License Plate*

VIN

Description of the Accident

Description of the Damage to the Rental Cat

Renter Signature

I hereby certify that the above statements are true and correct to the best of my knowledge and belief.

ACCIDENT AND DAMAGE FORM

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