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Feedback Incident Report
Download offline form here
Renter Information (Customer)
Name
Address
Email
City
Postal Code
Phone
Vehicle Use:
Business
Personal
Operator (Driver):
Insurance Company Info:
Rental Vehicle Information:
Plate:
Province:
Make/Model:
Rental Agreement:
Yes
No
Name of person completing form:
Date:
Incident Details:
Date of Incident:
Time of Incident:
City/Province:
Were Police Called?
Yes
No
Other Vehicles Involved?
Yes
No
Was Anyone Injured?
Yes
No
Incident Description:
Rental Vehicle Struck In Rear
Other Vehicle(s) Struck In Rear
Intersection Collision
Parking Lot Collision/ Incident
Parked & Unoccupied
Tire
Glass
Other
Send
