Business Auto Claims * Required Name of Business Contact Person Phone Number Date/Time of the Loss Description of the accident Name of driver involved Vehicle involved Were the police called NO YES Were tickets issued NO YES Were there any witnesses NO YES Is vehicle drivable NO YES Approximate description of damage Name of other Party Phone Number Driver License Number Date of Birth Name of other party Insurance Co. Policy Number Phone Number Describe Vehicle of other party Approximate description of damage to other party vehicle Any Bodily Injuries NO YES Send to Ana L. Menchaca Dominique Renaud

Houston Business Insurance · 3120 Southwest Freeway, Suite #101, Houston, Texas 77098 Licensed by the Texas State Board of Insurance · Serving Houston Businesses for Over 19 Years

Website services by: www.LuisHSanchez.com