Incident / Accident Report Form
Please use this form to submit information related to an incident or accident involving a vehicle rented from any of our locations. If you were online with any rideshare/delivery platforms it is required that you report the claim with them as well and provide us with the claim information. We will be reaching out to you within 1-2 business days to discuss the next steps.
Location you rented the vehicle from:
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Please Select
Dallas (Garland) - Northwest Highway
Houston - Star Lane
Austin - Round Rock
San Antonio - Fredericksburg
Atlanta - Enterprise Blvd SW
Phoenix - CARSTAR Seven5
Vehicle License Plate:
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Name
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First Name
Last Name
Phone number:
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Email
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example@example.com
Date & Time of Incident
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-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Type of Incident:
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Breakdown/Mechanical issue
Vandalism/Theft or Attempted Theft
Windshield Damaged/Cracked
Single vehicle incident (no other vehicles involved)
Accident involving rental car & another vehicle
Accident involving rental car &
multiple (2 or more)
other vehicles
Where did this take place? Nearest intersection or address.
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If you do not know address or cross-streets, please list a nearby business. Example: Behind the Boston Market on Centerville Rd.
Please give a statement of what occurred, please be specific as possible:
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Were the Police notified?
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Yes
No
(If yes) Please provide the police report number:
At the time this occurred, were you online working for Uber/Lyft?
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Yes, I was working
No, I was NOT working.
(If yes) which app were you online with?
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Please Select
i was driving for Uber.
I was driving for Lyft.
Did you have any passengers, or were you on the way to pick up a passenger?
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Yes, I had a Uber/Lyft passenger in the vehicle at the time of the accident.
I was on my way to pick up a passenger for a trip I had accepted.
No, I was online but had not accepted a trip.
Is the vehicle drive-able?
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Yes
No
Was the vehicle towed/impounded?
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Yes, the vehicle was towed from the scene.
No, I was able to drive the vehicle.
Did the airbags deploy in the vehicle you were driving?
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Yes
No
VEHICLE PHOTOS; please upload any photos of any of the vehicles involved in this accident.
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FILE UPLOAD: Use this to upload any other files you have that are relative to the incident (photos of insurance document of any 3rd parties involved, drivers license photos, etc)
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Please use this space to leave any additional information that may be helpful for the insurance team. (if you have reported the accident to UBER or Lyft, claim info is helpful)
In the event I receive additional information that would be useful for the resolution of the accident claim, I agree to share that with RideShare Carz & their insurance providers.
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Date of signing
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-
Month
-
Day
Year
Date Picker Icon
Hour Minutes
AM
PM
AM/PM Option
Submit
Submit
Should be Empty: