Johnson’s Auto Body has provided this form in case of an accident. Please print out a copy of this form for each vehicle and keep it in your glove compartment.

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Important Information To Gather And Exchange After An Accident

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Your Insurance Company ______________________________
Your Insurance Agent ______________________________

Accident Details:
Date of Accident _____________________________
Time of Accident _____________________________
Location _____________________________
Information About Other Driver:
Other Driver’s Name ______________________________
Address ______________________________
City ______________________________
State ______________________________
Zip code ______________________________
Phone _______________________________
Year/Make/Model
Of vehicle _________________________________
License Number & State _____________________________
Insurance Company ______________________________
Insurance Agent _______________________________
Policy Number _______________________________

Information From Witnesses:
Witness One
Name ______________________________
Phone ______________________________
Address _______________________________
City _______________________________
State _______________________________
Zip code _______________________________
Witness Two
Name _______________________________
Phone _______________________________
Address _______________________________
City ________________________________
State _____________________________
Zip code ______________________________
 

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Johnson’s Auto Body
701 West Main Street
Starkville, Ms. 39759
Phone: 662-323-0889

 

Quick Fact:
Did you know that you have the right to select the repair shop of your choice?
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