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Motor Vehicle Accident Information Form If you have an accident, you should obtain this information immediately Other Driver’s Name________________________________________________ Phone___________________________________________ Date of Birth__________________ Driver’s License Number_______________________ State of Issue______________________________
Car Owner’s Name ______________________Address______________________City____________________State________Zip__________ (Check the Vehicle Registration card for this information)
Vehicle Make______________________________ Model ______________________Year_______________ Color_____________________ (Example: Ford, Toyota, BMW)
(Example: Taurus, Prius)
Insurance Company______________________________________ License Plate Number _______________________State_______________
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