Gainesville Motorcycle Accident Attorneys | North Central Florida Personal Injury Lawyers

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Personal Information

Name:
Address:
City:
State:
Zip:
E-mail Address:
Home Phone:
Business Phone:
Cell Phone:
Fax Number:

Accident/Injury Information

Date of accident/injury:
Time of accident/injury:	:
Make of Motorcycle:
Model of Motorcycle:
Tire Size of Motorcycle:
Aftermarket modifications:
Make and Model of Vehicle at Fault:
Were any citations or traffic tickets issued?	Yes No
If yes, to whom?
Do you know for what traffic violation the ticket was issued?
Do you know the name of the other driver's insurance company?
Did you have insurance at the time of the crash?	Yes No
Do you have a copy of the accident/crash report
Did the other driver make any statements that you can recall?	Yes No
If yes, what were the statements and to whom did the driver make them?
Location of accident/injury?
If yes, with what insurance company were you insured?
Type of injuries suffered:
In as much detail as possible, please describe the accident and your injuries.
How were you referred to Uman Law Firm?
How did you hear about this website?

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The information on this Gainesville Motorcycle Accident Attorney / Law Firm website is for general information purposes only. Nothing on this or associated pages, documents, comments, answers, emails, or other communications should be taken as legal advice for any individual case or situation. This information on this website is not intended to create, and receipt or viewing of this information does not constitute, an attorney-client relationship.

Phone: (352) 372-7077 Fax: (352) 372-8770