Auto Accident Report

Please click the "Send Report" button after completing the following form.

This report serves only as a method of informing your agent of a loss. However, it is still necessary to contact your agent in person. Upon receiving this report, an agent will attempt to contact you immediately.

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Insured Information

Insured Name
Insured Address

City		State		Zip
County

Insured Resident Phone

Insured Business Phone

E-Mail

Contact Information

Contact Name(if different)
Where to Contact
When to Contact

Contact Resident Phone(if different)

Contact Business Phone(if different)

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Loss Information

Location of accident
Description of accident
Authority information(reports filed, violations cited)

Insured Vehicle Description

Vehicle #1 (Year, Make & Model)

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Owner Information(if different from insured)

Owner Name
Owner address

Driver Information(if different from insured)

Driver Name
Driver Address

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For additional information, please e-mail us at:

MAYO@mayo-insurance.com

Call at 1-802-485-6061 or

1-800-982-5849

or fax us at 1-802-485-6065.

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