Wild Sky Law Group - (425) 646-2773
"Helping you weather the storm."
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Email *
COLLISION SCENE INFORMATION FORM
Use this form to collect information at a collision scene - This does not create an attorney-client relationship.
Date of collision *
MM
/
DD
/
YYYY
Your name: *
Your email (this form will be emailed to you and you authorize us to contact by email) *
Your phone number (by submitting this, you authorize me to call you at this number) *
OTHER DRIVER INFORMATION:
Other Driver Name *
Other Driver Physical Address *
Other Driver Phone Number *
Other Driver's License Number *
Other Driver's Email (optional)
Other Driver's Vehicle Year, Make, Model *
Other Vehicle License Number *
Other Vehicle Insurance Company *
Other Vehicle Insurance Policy Number *
TAKE PICTURES (*only if it is SAFE to do so*)
WITNESS INFORMATION (Name/Phone/Address/Email)
A copy of your responses will be emailed to the address you provided.
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