Contact Us - Collision Safety Consultants DMV

Collision Safety Consultants of Virginia, Maryland, and Washington DC

Collision Safety Consultants of Virginia, Maryland, and Washington DC

Insurance Claim Information Form

Please complete the form below with your vehicle and insurance claim information.

Our Team at Collision Safety Consultants will review your info and will follow-up with a conversation about how we can maximize your claim.

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Your Name *

First

Last

Address

City

State

Zip

Phone Number *

Email *

In what State is your vehicle registered?

Other state where vehicle is registered (if not listed above)

Vehicle Year

Vehicle Make (e.g. Ford)

Vehicle Model (e.g. Mustang)

Vehicle identification number (VIN)

The VIN can usually be found on your insurance card or registration.

Odometer mileage at the time of loss

In what State did the collision occur?

Other state where collision occurred (if not listed above)

How did you purchase your vehicle?

I would like to:

Dollar amount of damage to the vehicle

Name of your insurance company that will be paying the claim

Claim Number