Accident Claim

Accident Claim

This form is to be filled out by customer with attendant present
Customer Full Name

First NameLast Name
Customer Email*
Customer Phone Number
Account/Location
Ticket/Resident Number
This form together with your name, our company's name and lot number, are to be given without comment or delay to anyone ("Claimant") making a claim against Valet King for auto damages, property damages, thefts, or personal injuries. If the Claimant is unwilling or unable to cooperate, you should immediately fill out this form to the best of your ability.

1. We sincerely regret any problems that you may have experienced as a possible result of our service. This form, when completed by you, will provide the information and signature required to begin processing your claim.

2. Our Employees are not authorized to admit or deny the validity of your claim. They are authorized only to present and accept this form. Our presentation and acceptance of this form is neither an admission nor denial of responsibility.

3. The applicable sections of this form must be completed to the best of your ability and submitted promptly in person to our employees at the location of the alleged incident.4. It is a felony to present fraudulent claims to an insurance company.
Customer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Drivers License #
License Plate #
Color
Year
Make
Model
Date
Accident Location Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Time In
Driven By
Time Out
Driven By
Was Damage Reported Before Customer Left Premises?

YesNo
Indicate Type of Damage
Injured Persons
Witnesses
Was Theft Reported to Police

YesNo
Report #
Report Filled Out By

First NameLast Name
Phone Number

Area CodePhone Number
I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF.
1. Send an email with all pertinent information in support of your claim to:

Info@parkvaletking.com

2. As soon as your letter is received, your claim will be processed and you will be contacted within 48 hours from claims department.

3. It is a felony to present a false or fraudulent claim to an insurance company.

4. Send original of this form and all other required forms to info@parkvaletking.com

5. If a body shop estimate is required please see email recived once this form is submitted.

www.Valetking.com
Customer Name

First NameLast Name
Date

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