Accident Recovery Form

Please complete this form and click Submit to send your request.
Or you may print and mail or fax this form. (Click here for printer-friendly version.)

Mail to:
Attn: Jacob Liddell
Liddell Brother, Inc.
600 Industrial Drive
Halifax, MA 02338

Fax to:
781-293-4791

Your Name (*required)

Your Company

Your Email

Phone Number (*required)

Date of Loss

File / Claim #

Insured Name

Operator Name

Accident Street/Route

Accident Town/City

Accident State

Nearest Landmark

Other Landmarks

Property Damage

Accident Investigated by State Police?
Yes No 

Accident Investigated by Local Police?
Yes No 

Any Additional Comments?