ELITE PARKING INCIDENT REPORT

ELITE PARKING INCIDENT REPORT

Please fill out this form accurately to eliminate any possible delays. If you have any questions, please contact us immediately.All fields with the red (*) are required.
The name and photo associated with your Google account will be recorded when you upload files and submit this form.
General Information
Date Of Incident*

MonthDayYear
Date
Elite Location Of Incident*
Last Name of the Person Filling Out This Incident Report*
First Name of the Person Filling Out This Incident Report*
Email Address of the Person Filling Out This Incident Report*
example@example.com
Phone Number of the Person Filling Out This Incident Report*

Area CodePhone Number
Select Your Location Manager*
Select Your Division Manager*

INCIDENT REPORT SELECTION
What Type of Incident Occurred?*

Vehicle DamageLost or Missing ItemsLocation Property DamagePersonal / Bodily Injury

VEHICLE DAMAGE - Customer Information

Please provide the CUSTOMERS INFORMATION for the VEHICLE CLAIM.
Customer Last Name (Vehicle)*
Customer First Name (Vehicle)*
Customer Street Address (Vehicle)*
Customer City (Vehicle)*

HonoluluOther
Customer State (Vehicle)*

HawaiiOther
Zip Code (Vehicle)*
Primary Customer Phone Number*

Area CodePhone Number
Secondary Customer Phone Number

Area CodePhone Number
Customer Email Address*
example@example.com
Picture of Customer ID (Vehicle)

Browse Files
Please be sure address is legible Cancelof
Explain if no picture

VEHICLE DAMAGE - Vehicle Information

Please make sure that vehicle information is accurate. Failure to do so will cause unnecessary delays in processing the claim.
Personal or Rental Vehicle?*

PersonalRentalTuro
Rental Car Company Name*
Insurance Company (Vehicle)
Picture of Insurance

Browse Files

Cancelof
Explain if no pic or information
Vehicle Year*
Vehicle Make*
Vehicle Model*
Vehicle Color*
Vehicle License Plate*
Vehicle License Plate State*

PERSONAL / BODILY INJURY - Customer Information

Please provide the INDIVIDUALS INFORMATION for the PERSONAL / BODILY INJURY
LAST NAME (Personal)*
FIRST NAME (Personal)*
ADDRESS (Personal)*
CITY (Personal)*

HonoluluOther
STATE (Personal)*

HawaiiOther
ZIP CODE (Personal)*
EMAIL ADDRESS (Personal)*
Customer Primary Phone Number*

Area CodePhone Number
Customer Secondary Phone Number

Area CodePhone Number
PICTURE OF CUSTOMERS ID (Personal)

Browse Files
Please be sure address is legible Cancelof
Explain if no picture
POLICE REPORT # (Personal)
Explain if no police report
ADD PICTURES OR VIDEOS OF INCIDENT (Personal)

Browse Files

Cancelof
Explain if no pictures or videos

PROPERTY DAMAGE - Customer Information

Please provide the CUSTOMERS INFORMATION for the PROPERTY DAMAGE
LAST NAME (Property)*
FIRST NAME (Property)*
ADDRESS (Property)*
CITY (Property)*

HonoluluOther
STATE (Property)*

HawaiiOther
ZIP CODE (Property)*
EMAIL ADDRESS (Property)*
Customer Primary Phone Number *

Area CodePhone Number
Customer Secondary Phone Number

Area CodePhone Number
PICTURE OF CUSTOMERS ID (Property)

Browse Files
Please be sure address is legible Cancelof
Explain if no picture

PROPERTY DAMAGE - Customer Vehicle Information

Please make sure that vehicle information is accurate. Failure to do so will cause unnecessary delays in processing the claim.
Personal or Rental Vehicle?*

PersonalRental
RENTAL CAR COMPANY NAME (Vehicle)
INSURANCE COMPANY (Vehicle)*
VEHICLE YEAR (Vehicle)*
VEHICLE MAKE (Vehicle)*
VEHICLE MODEL (Vehicle)*
VEHICLE COLOR (Vehicle)*
VEHICLE LICENSE PLATE (Vehicle)*
VEHICLE LICENSE PLATE STATE (Vehicle)*
POLICE REPORT # (Property)
Explain if no police report
ADD PICTURES OR VIDEOS OF INCIDENT (Property)

Browse Files

Cancelof
Explain if no pictures or videos

LOST / MISSING ITEMS - Customer Information

Please provide the CUSTOMERS INFORMATION for the LOST / MISSING ITEMS
LAST NAME (Items)*
FIRST NAME (Items)*
ADDRESS (Items)*
CITY (Items)*

HonoluluOther
STATE (Items)*

HawaiiOther
ZIP CODE (Items)*
Customer Primary Phone Number*

Area CodePhone Number
Customer Secondary Phone Number

Area CodePhone Number
EMAIL ADDRESS (Items)*
example@example.com
PICTURE OF CUSTOMERS ID (Items)

Browse Files
Please be sure address is legible Cancelof
Explain if no picture

LOST / MISSING ITEMS - Customer Vehicle Information

Please make sure that vehicle information is accurate. Failure to do so will cause unnecessary delays in processing the claim.
RENTAL CAR COMPANY NAME (Items)
INSURANCE COMPANY (Items)*
VEHICLE YEAR (Items)*
VEHICLE MAKE (Items)*
VEHICLE MODEL (Items)*
VEHICLE COLOR (Items)*
VEHICLE LICENSE PLATE (Items)*
VEHICLE LICENSE PLATE STATE (Items)*

HawaiiOther

LOST / MISSING ITEMS - Valet Information
WAS THE VEHICLE IN OUR POSSESSION (Items)

YesNo
WAS THE VEHICLE VALETED (Items)*

YesNo
NAME OF VALET "IN" (Items)*
NAME OF VALET "OUT" (Items)
IS VALET DRIVER RESPONSIBLE FOR DAMAGE?

YesNoElite is responsible but trying to identify if the valet driver is at faultOther

DETAILED EXPLANATION

INTERNAL USE ONLY Anything entered into the is section WILL NOT BE SENT OR SHARED WITH THE CUSTOMER. PLEASE PROVIDE AS MUCH DETAILS AS POSSIBLE (When, What, Where, When, & Why)
In your opinion, is Elite Parking liable for damages*

Yes, I believe Elite IS liable for damagesNo, I believe Elite IS NOT liable for damagesUnder Investigation
PLEASE EXPLAIN: Why Elite IS or IS NOT liable for damages*
PLEASE EXPLAIN: Who, What, Where, When, & Why (Internal Use Only)*

READY TO SUBMIT

If you need to check your responses to the incident report form, click the BACK button. You and your manager will receive a confirmation email of the claim. If you have any questions, please contact claims@eliteparking.net
Should be Empty:

The name and photo associated with your Google account will be recorded when you upload files and submit this form.