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: Craig Barnard
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?
    YesNo

    Accident Investigated by Local Police?
    YesNo

    Any Additional Comments?