CCS App Demo

The information you collect and record here is typically what both the police collision report centres and your insurance company will require.

A summary of this information will be e-mailed to the address you specify so that you can keep it for your records. The bodyshop will also receive a copy of this e-mail.

An asterisk (*) denotes a required field.

General Information:

* Date Of Collision

* Time Of Collision:

* My E-Mail Address:

Location of Collision:

Officer Name:

Badge #:

Indicent #:

Tow Truck Information:

Tow Truck Company:

Tow Truck Number:

Other Driver and Vehicle Information:

Other Driver Name:

Other Driver's License Number:

Address:

* Primary Phone #:

Type:

Secondary Phone #:

Type:

VIN:

License Plate:

Make, Model & Colour:

Insurance Company:

Policy #:

Expiry Date:

# Of Persons is other Vehicle:

Witness #1 Information:

Name:

Address:

Phone Number:

Witness #2 Information:

Name:

Address:

Phone Number:

Other Notes & Information:

Please enter any additional notes or information regarding your collision. You have 2048 characters.

Record Info

Record Your Accident Info

General Information:

Tow Truck Information:

Other Driver and Vehicle Information:

Witness #1 Information:

Witness #2 Information:

Other Notes & Information: