ACCIDENT INFORMATION CARD FROM
THE ATTORNEYS AT MMMPALAW.COM

If you are involved in an automobile accident, it is very important that you obtain as much basic information as possible, regardless of who was at fault. Fill out this form at the scene of the accident or as soon afterwards as possible.

Date: _______________________________________________________________
Time: _______________________________________________________________
Location: _______________________________________________________________
Driver 1 Driver 2
Name: _______________________________ _______________________________
Phone #: _______________________________ _______________________________
Address: _______________________________ _______________________________
Driver's Lic. #: _______________________________ _______________________________
Date of Birth: _______________________________ _______________________________
Soc. Sec. #: _______________________________ _______________________________
Vehicle 1 Vehicle 2
Make: _______________________________ _______________________________
Model: _______________________________ _______________________________
Year: _______________________________ _______________________________
License Plate 1 License Plate 2
State: _______________________________ _______________________________
Owner's Name: _______________________________ _______________________________
Phone #: _______________________________ _______________________________
Address: _______________________________ _______________________________
Passenger 1 Passenger 2
Name: _______________________________ _______________________________
Phone #: _______________________________ _______________________________
Address: _______________________________ _______________________________
Witness 1 Witness 2
Name: _______________________________ _______________________________
Phone #: _______________________________ _______________________________
Address: _______________________________ _______________________________