INFORMATION YOU SHOULD OBTAIN WHEN IN A MOTOR VEHICLE COLLISION LAW OFFICES OF DAVID S. GREENE COLLISION INFORMATION FORM 1. The Collision: Date of Collision:____________________ Time:______________Day of Week__________ Location of Collision (Give both streets if at an intersection): ____________________________________________________________________________ City_________________________________ State_________________________________ Stop Signs or Traffic Signals_________________________________________________ Description or Diagram: Describe Property Damage to Vehicle(s): 2. The At Fault Driver: Name of Other Driver:______________________________________________________ Name of Owner, if Different than Driver:______________________________________ Address of Driver:__________________________________________________________ City____________________________ State_________________ Zip_________________ Telephone: (Home)_________________________(Cell)_________________________ (Work)__________________________ Address of Owner, if different than driver: ________________________________________ City____________________________ State________________ Zip____________________ Insurance Company of Driver/Owner:___________________________________________ Policy #___________________________________ Make & Model of Vehicle that Collided with You:__________________________________ License Plate Number & State: ______________________ 3. People at or arriving on the scene: Name of Police Dept. that investigated: __________________________________________ Police Report #:____________________________________ Name of Officer:____________________Badge #__________Phone#____________________ Witness:____________________________________________________________________ Address:_____________________________________________________________________ City ________________________________ State__________________ Zip______________ Phone #:___________________________ Witness #2:__________________________________________________________________ Address:_____________________________________________________________________ City __________________________________State____________________ Zip____________ Phone #:___________________________ Name of Towing Company:_____________________________________________________ Address:______________________________________________________________________ Telephone #:________________________ Emergency Personnel:__________________________________________________________