Liddell Brothers - Accident Recovery

Accident Recovery Form

Please complete this form and click Submit to send your request.
Or you may print and mail or fax this form.
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Mail to:
Attn: Jacob Liddell
Liddell Brother, Inc.
600 Industrial Drive
Halifax, MA 02338

Fax to:
781-293-4791

Your Name
Your Company
Phone	Ext:
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
Enter Any Additional Comments Here: