Incident Report Form

Automobile Incident Report Form

To assist us in the prompt processing of this information, please complete this incident report form.
This report to be completed for damage to hotel vehicles or damage caused by valet. For all other guest vehicle damage, please complete a guest incident report.
Site Code: (this is the 3 digit site code assigned by Concord)*
Hotel Name: *
Hotel Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Hotel Phone#:*

Area CodePhone Number
Hotel GM's Contact Information:*

First NameLast Name
Hotel GM's Email:*
example@example.com
Your Name*

First NameLast Name
Your Email:*
example@example.com
Who is the RVP for your hotel?
YesNo
Concord ManagedThird Party Managed
Automobile Owner's Name*

First NameLast Name
Automobile Owner's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Automobile Owner's Phone Number*

Area CodePhone Number
Automobile Make/Model and Year*
YesNo
Witness Name*

First NameLast Name
Witness Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Witness Phone Number*

Area CodePhone Number
Date Incident Occurred: *

MonthDayYear
Date
Description of the incident and damage:*
In your most precise words, describe in as much detail the incident that occurred.
When filing include photos of damaged items, guest folio, police report, and/all other supporting documentation.
Please upload any files or images associated with the incident.

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Automobile Incident
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Automobile Incident Report Form