ACCIDENT INFORMATION
| Date of accident: | Time: | AM/PM: | |
| Location: | Cross streets: | ||
| Weather: | Visability: | ||
| Road conditions: | Traffic conditions: | ||
| Traffic signs or signals: | Street lights: | ||
| Was other driver intoxicated? | |||
| Speed of your car: | Speed of other car: | ||
| Did other driver signal? | Seat belts worn? | ||
| Was either driver turning? | |||
| Headlights: | Stoplights: | ||
| Turn signals: | |||
| Distance from other car when you first saw it: | |||
| Measure skid marks: | |||
| Curves, curbs, hills, debris: | |||
| Pedestrians: | |||
| Other remarks: | |||
POLICE (OR HIGHWAY PATROL)
| Dept: | Name: |
| Badge Number: | Phone: |
| Arrest or citations: | Report taken: |
WITNESSES
| 1. Name: | Phone: | ||
| Street Address: | City: | State: | |
| 2. Name: | Phone: | ||
| Street Address: | City: | State: | |
| 3. Name: | Phone: | ||
| Street Address: | City: | State: | |
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| Licensed in State of California. | LICENSE #: 0787078 |
| Phone: (800) 316-3002 Fax: (818) 500-1855 |
Email: |
info@firsteagle.com