• Type a question

  • Accident Report

    VEHICLE ACCIDENT ONLY - 2 CAR INVOLVED

  • REPORT ALL VEHICLE INCIDENTS IMMEDIATELY REGARDLESS OF SEVERITY OR FAULT
    SAFETY FIRST: Move your vehicle to a safe location
    ☐ Turn on your emergency flashers
    ☐ Shut down, exit (if your personal safety is not at risk), and lock your vehicle
    REPORT THE INCIDENT: Call the police and Request medical assistance, if needed.
    ☐ Do not move your vehicle until the police arrive (if dispatched)

  • ☐ Call the On-Road Emergency Hotline: 1 800-942-3300 (Available 24/7) Report the incident. Record D*
     - -
  • Accident Date & Time*
     - -

  • Vehicle Information

  • Vehicle Year      Vehicle Make      
    Vehicle Model      Vehicle License Plate      
    Vehicle #      

  • Third Party Vehicle Information

  • Format: (000) 000-0000.

  • Vehicle Year      Vehicle Make     
    Vehicle Model      

  • Description of Accident

  • Road Construction
  • Road Attitude
  • Traffic Conditions
  • Light Conditions
  • Road Conditions
  • Weather Conditions

  • Additional Info

  • Format: (000) 000-0000.
  • Citation Issued

  • Photo of Accident

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  • Please take additional photos and video. Send all collected pictures, videos and documents to amanji@elitestarexpress.com

  • Property Damage

  • Date*
     - -
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  • General Incident

  • Incident Date & Time
     - -
  • Should be Empty: