If you need police, emergency medical assistance, or are in an unsafe location, please dial 911. To request Emergency Roadside Service or towing, please call 800-654-5060 for assistance.
To complete an accident report online, please complete the form below.

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Details
Involved
Summary
Submit

Do you have either the rental vehicle license plate or rental agreement number?

Please return to this form to submit once you have the rental agreement or license plate information. If you need help locating your rental agreement number, please visit: https://www.hertz.com/rentacar/receipts/request-receipts.do Once the rental agreement number is obtained, please click "Start Over" to reset the form and complete submission

Incident Details

Incident Location

Street, mile marker, etc...

Incident Details


Parties Involved

Renters Information

Renters Insurance Information

Please provide name of employer and address

What was the status of your ride sharing App at the exact time of the incident?

Drivers are encouraged to report an incident directly in the Lyft app by tapping “Help” in the app menu. You can also report the accident directly on their website at this LINK.

Drivers are encouraged to report an incident directly in the Uber app by tapping “Help” in the app menu. You can also report an incident with Uber’s 24/7 support line at (800) 593-7069 or filling out their online accident reporting form by clicking this LINK.

UNKNOWN

Driver's Information

Driver's Insurance Information

Other's Information

Other's Insurance Information

Other's Vehicle Information

# First Last Address Phone# Age Pedestrian
Add Injured Person

Submitter's Information


Summary

Details Edit


License Plate:

Rental Agreement Number:

Date and Time of Incident:

Incident Location:

Incident Description:

Rental Vehicle Damage:

Vehicle Towed:

No

Police Notified:

No

Involved Edit


Do you have the renter’s name and/or contact information?:

NO

Is the driver of the rental vehicle the same as the renter:

YES

Was another party involved in the accident:

NO

Was anyone injured:

YES

Is the person submitting the incident report the same as the renter:

YES

Injured Details

# First Last Address Phone# Age Pedestrian

Submit

PLEASE MAKE SURE YOU SCROLL TO THE BOTTOM TO SELECT THE SUBMIT BUTTON.

If you plan to submit this claim to your insurance or credit card company, please contact them immediately to start the claim process. Failure to report this claim timely may result in coverage denial from your credit card issuer, please refer to your policy for more detail. Please use the text box below to add in any additional comments.


IMPORTANT DAMAGE RESPONSIBILITY NOTICE
In most cases, if Loss or Partial Damage Waiver was not accepted at the commencement of the rental, or you do not have other contractually provided damage coverage,* the person whose name appears on the Rental Agreement will be held financially responsible for damage to the rental vehicle.

In many cases your own automobile insurance policy and/or some charge card companies cover damage to a rental vehicle. In order to be eligible for such benefits, you should notify your automobile insurance carrier and/or charge card company as soon as possible of a potential claim. A delay in notifying them may limit or entirely negate coverage, especially in the case of coverage provided by charge card companies.

*Please refer to the specific terms and conditions provided to you at the time of rental to determine your specific level of damage responsibility.

RENTALS IN NEW YORK ONLY:
FAILURE TO COMPLETELY AND ACCURATELY FILL OUT AND RETURN AN INCIDENT REPORT WITHIN TEN DAYS OF RECEIPT OF THIS NOTICE MAY MAKE THE AUTHORIZED DRIVER LIABLE FOR DAMAGES SUSTAINED TO THE RENTAL VEHICLE. EXCEPT WHERE THE DAMAGED VEHICLE IS DETERMINED TO BE A TOTAL LOSS AND SUBJECT TO SALVAGE, THE AUTHORIZED DRIVER OR HIS OR HER INSURER HAS SEVENTY-TWO HOURS FROM THE RETURN OF THE VEHICLE TO NOTIFY THE RENTAL COMPANY THAT HE OR SHE WISHES TO INSPECT THE DAMAGED VEHICLE. THE INSPECTION MUST BE COMPLETED WITHIN 7 BUSINESS DAYS OF THE RETURN DATE OF THE VEHICLE. IF THE AUTHORIZED DRIVER OR HIS OR HER INSURER DOES NOT REQUEST THIS INSPECTION WITHIN THE 72 HOUR PERIOD, THE AUTHORIZED DRIVER OR HIS OR HER INSURER WILL BE DEEMED TO HAVE WAIVED THIS RIGHT. IF THE RENTAL COMPANY DETERMINES THE DAMAGED VEHICLE TO BE TOTAL LOSS AND SUBJECT TO SALVAGE, SUCH 72 HOUR PERIOD FOR NOTIFICATION OR WAIVER OF THE WISH TO INSPECT THE DAMAGED VEHICLE SHALL NOT APPLY, AND SUCH RIGHT TO INSPECT THE DAMAGED VEHICLE SHALL EXPIRE TEN BUSINESS DAYS FROM THE AUTHORIZED DRIVER’S RECEIPT OF THIS NOTICE FROM THE RENTAL VEHICLE COMPANY AT THE RETURN OF THE VEHICLE OR RECEIPT OF THE FIRST MAILING OF THIS NOTICE IN THE EVENT OF THE RETURN OF THE VEHICLE BY AUTOMATION OR AFTER HOURS. UPON REQUEST OF THE AUTHORIZED DRIVER OR HIS OR HER INSURER, WE WILL PROVIDE A COPY OF OUR ESTIMATE OF THE COSTS OF REPAIRING THE DAMAGED MOTOR VEHICLE.


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