Title Page
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Claim Number
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Conducted on
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Prepared by
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Incident Location
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Claim Department contact info: claimdepartment@supremeparking.net | (562)745-7531
Inspection Information
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Time incident reported (24H format)
Vehicle Information
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Vehicle Owner
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Vehicle Identification Number
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Vehicle Year, Make & Model
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Type of Claim
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Was incident reported prior to leaving?
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Is this Vehicle a rental?
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Provide picture of Rental agreement.
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Where the police called?
Police Information
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Officers Business Card Photo
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Officers Name
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Officers Phone Number
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Officers Report #
Claimant Information
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Claimant Name
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Claimant Phone number
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Claimant Email
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Claimant Mailing Address
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We always recommend a detailed incident statement, to conduct a thorough and proper investigation.
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Summary/description of Damage
Employee Section
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Valet Ticket Number
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Valet Storage Stall # or Location
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Was damage noted on damage Assesment?
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Damage Assesment Ticket Vehicle Drawing side
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When incident occurred had car been turned over to us?
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Valet that Parked Vehicle
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Valet that Parked Vehicle phone number
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Valet that Retrieved vehicle
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Valet that Retrieved vehicle phone number
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Summary of incident
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Take photo evidence of vehicle damage
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Take photo(s) of the surrounding vehicle and/or environment involved
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Signature of Supervisor or Valet completing report
Summary
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Additional comments
