CBIZ Glove Box Cards

Print and cut out these cards, and keep them with you in your vehicle:

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CBIZ Insurance EXCHANGE OF INFORMATION FORM (Complete and give to the other parties involved in the accident.) Policyholder's Name:  _________________________________________ Address:  _____________________________________________________ ____________________________________________________________ Daytime Phone:  _______________________________________________ Insurance Agent:  _____________________________________________ Insurance Company:  ___________________________________________ Insurance Company Phone #:  ___________________________________ Policy #:  ____________________________________________________ The CBIZ Companies 1-888-418-2500

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CBIZ Insurance WITNESS CARD (Please complete and return to driver - Thank You.) Date and time of accident:  _________________________________ Did you see the accident?  _________________________________ Did anyone appear injured?  ________________________________ Were you a passenger?  _____________________________________ Where were you at time of accident?  _______________________ How did the accident happen?  ______________________________ __________________________________________________________ __________________________________________________________ Your name:  _________________________________________________ Address:  ___________________________________________________ ________________________________________ Zip:  _______________ Daytime phone number:  ______________________________________ What was your destination?  ________________________________ Where did you depart from?  ________________________________ Use reverse side if necessary. The CBIZ Companies 1-888-418-2500

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