Incident Notification Form

The Incident Notification Form is for incidents involving Summers-Taylor, Inc. vehicles and third party auto & property damage. The information required below will be used to investigate your incident. Please ensure that all available information is ﬁlled out below. If you have photos and videos, please attach them to this form when submitting. If not, it could delay how long it takes to process the investigation.

Submitting Notification For?*

Individual
Business

Business Name

Name*

First Last

Phone*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Email Address*

Preferred Method of Contact?*

Phone
Text
Email

What Happened?

Describe in detail the incident/ event, including what occurred immediately before and after, Summers-Taylor vehicle description, truck number, equipment, etc.

Incident/Event Date*

MM

DD

YYYY

Incident/Event Time*

: HH

MM

Location/Address of Incident*

Street Address City State / Province / Region ZIP / Postal Code

Description:*

Describe in detail the incident/ event, includin gwhat occurred immediately before and after, Summers-Taylor vehicle description, truck number, equipment, etc.

Damage Information:

What is Damaged?*

Personal/Company Vehicle
Private Property
Both

Damage Type:*

Rock/Tar Damage
Property (Mailbox, Driveway, sidewalk, etc.
Other

For Vehicle:

Year Make Model Color

For Property:

Describe Property Damage

File

Drop files here or

Incident Notification Form