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About Us
How It Works
FAQ
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Chauffeur
Rideshare and Delivery
Fleet
Deals
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Partner
Contact Us
Accident/Claims Report
Where luxury meets lifestyle
Accident & Claims Report
You will receive a communication from the claims department within 2 business days of submission of this form. You may contact the claims department by calling 407.494.6088
Submit A Claim Immediately
ACCIDENT/INCIDENT
*
Select
ACCIDENT
INCIDENT
GLASS/TIRE
Select
GLASS
TIRE
RENTAL VEHICLE INFORMATION
YEAR/MAKE/MODEL
*
UNIT#
*
RENTAL AGREEMENT#
*
AREA DAMAGED
WAS VEHICLE TOWED?
TOWED TO
TOWING COMPANY PHONE#
FACTS OF ACCIDENT
DATE OF ACCIDENT
*
TIME
*
POLICE DEPARTMENT HANDLING
POLICE REPORT#
LOCATION OF ACCIDENT (STREET, CITY AND STATE)
*
DETAILS OF INCIDENT
INJURIES IN FOX VEHICLES
RENTER/DRIVER INFORMATION
RENTER
*
DOB
DRIVER
*
DRIVER M/F
DRIVER DOB
DRIVERS LICENSE#
*
STATE
*
EMAIL
HOME ADDRESS
HOME PHONE#
INSURANCE CO. & PHONE#
WORK PHONE#
POLICY#
3rd PARTY VEHICLE INFORMATION
REGISTERED OWNER
DOB
DRIVER
M/F
DRIVERS LICENSE#
STATE
EMAIL
HOME ADDRESS
HOME PHONE#
WORK PHONE#
INSURANCE CO. & PHONE#
YEAR/MAKE/MODEL/LICENSE PLATE#
AREA DAMAGED
WERE PARAMEDICS OR OTHER MEDICAL PERSONNEL CALLED TO THE ACCIDENT SCENE?
POLICY#
INJURIES?
DATE
*
SIGNATURE
*
COMPLETED BY
*
Submit