ACCIDENT / INCIDENT REPORT - Budget Car Rental
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ThankyouforcompletingourAccident/IncidentReportProcess. Incidents,accidentsandvehicletheftsarenotsomethingweliketo thinkabout,especiallyonabusinesstriporvacation,buttheycan anddohappeneventothemostcarefuldrivers.
YoucantypicallyexpecttohearfromAvisBudgetGroupina30day timeframefromthedateoftheincident.
Intheinterim,pleasecontactyourInsuranceCompanyorCredit CardCompanytoestablishaclaimwiththem.Youdonotneedany paperworkfromustobeginthisprocess.
Forinquiriesregardingyourclaim,pleasefeelfreetocontactAvis BudgetGroupatthephonenumberoremailaddressbelow.Please besuretoprovideyourRentalAgreementnumberorMVAnumber listedbelowwhencontactingustoinquireaboutyourclaim.
ThankyouforchoosingAvisBudgetGroupforyourrentalneeds.
RentalAgreement:_______________________________
MVA:__________________________
Avis18664468376orBudget18005515998
llaaiimmsseettuupp@@aavviissbbuuddggeett..ccoomm
ACCIDENT / INCIDENT REPORT
RENTER INFORMATION (CUSTOMER)
NAME:
ADDRESS:
CITY, STATE, ZIP:
EMAIL:
PHONE (PREFERRED CONTACT #):
VEHICLE USE
BUSINESS
PERSONAL
(IF BUSINESS PLEASE LIST NAME OF COMPANY)
OPERATOR (DRIVER): INSURANCE COMPANY INFO:
INCIDENT DETAILS
DATE OF INCIDENT:
TIME OF INCIDENT:
AM/PM
CITY/STATE/PROVIDENCE
WERE POLICE CALLED?
YES
NO
IF YES, PLEASE PROVIDE POLICE DEPT / RPT#:
OTHER VEHICLES INVOLVED: IF YES, PLEASE PROVIDE: OWNER/DRIVER NAME: CONTACT PHONE #: ADDRESS: CITY/STATE/ZIP CODE
YES
NO
YR/MAKE/MODEL: INSURANCE INFORMATION:
RENTAL VEHICLE INFORMATION
MVA:
PLATE:
STATE:
MAKE/MODEL
RENTAL AGREEMENT:
NAME OF PERSON COMPLETING FORM (Please print):
WAS ANYONE INJURED? IF YES, PLEASE PROVIDE: PARTY INJURED: CONTACT INFO:
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 (PLEASE PROVIDE DESCRIPTION):
RENTER SIGNATURE
DATE
TO CONTACT US:
TOLL FREE: AVIS 866-446-8376 BUDGET 800-551-5998 EMAIL: fru.claimsetup@
FAX #'s - (AVIS) 720-479-4034 (BUDGET) 407-850-4743
F-5A (12/16)
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