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ACCIDENT / INCIDENT REPORT

Greetings. We take accountability seriously. If you desire to make a claim, please read the disclaimer at the bottom of the page. Then complete the form below including as many details as possible. This allows us to address the information with precision and speed. Thank you. 
Notice to Claimant(s): 

1. This form is to report information to the Company solely. No liability and/or negligence is determined until an investigation is completed by the Company's management team. By submitting this form you acknowledge to have read, understand and agree to all it's contents.

 

2. Company team members are not authorized to admit or deny the validity of any claim. They are only permitted to introduce this form to the Claimant(s), assist them in filling it out and/or may complete themselves. 

 

3. The Company is adequately insured against claims. IT'S A CRIME TO PRESENT FALSE INFORMATION AND/OR INITIATE A FRAUDULENT CLAIM.

 

4. If Company is found negligent, we sincerely regret any inconvenience you may have experienced as a result of our service.

Notice to Team Member(s): 

All accidents, incidents and/or claims are to be reported to the Company phone as soon as possible. 

CLAIMANT

Name
First *
Last *
Contact Info
Phone *
Email *

DETAILS

Date of Claimed Incident *
MM/DD/YYYY
Time of Claimed Incident *
00:00 AM/PM
Please Choose Incident Type
Valet(s) Name Involved
Witness Name (if applicable)
First 
Last
Location Name (if applicable)
Was valet informed before leaving the premises? Yes / No *
Phone (if applicable)
Arrival Time *
Departure Time *
00:00 AM/PM
00:00 AM/PM
Address *
Street 1     
Street 2     
City
State
Zip Code

VEHICLE

NOTE: If this claim includes more than 1 vehicle, please submit a separate form for each vehicle.
Make 
Model
Year
Describe Incident and/or Damage In Detail *
Please take photos of relevant items and email them to info@valetforms.com separately. Especially vehicle damage (if necessary).
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Damage Photos
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NOTICE OF WAIVER AND LIMITATION OF LIABILITY

​

THIS CONTRACT IS PRESENT ON ALL TICKETS & VALET BOXES.
PLEASE READ.
 

Patron and Valet Company agree to the following terms as an express condition of Valet Company accepting Patron’s vehicle for parking:
 

Valet Company provides a convenient means of parking and retrieving vehicles only and does not provide security for Patron’s vehicle or its contents. This is a license to park, no bailment is created. Vehicle is parked at owner’s risk. Leave ignition and door keys only. 
 

Patron agrees to hold Valet Company harmless for all intentional or negligent acts of third parties, including but not limited to collisions, door dings, vandalism and/or theft of vehicle, its components or contents. Patron agrees to remove or secure all article/valuables in the vehicle. Valet Company is not responsible for any articles left in car nor will Valet Company accept possession or bailment of such articles. 
 

Valet Company is not responsible for damage caused in whole or in part by fire, acts of nature, defective brakes, electrical components or other mechanical problems with Patron’s vehicle. 


Valet Company is not responsible for damage to Patron’s vehicle not directly caused by collision, including but not limited to damage to mirrors, door handles, seats, visors, steering wheels or electric windows and/or tops. Patron agrees to roll up windows and close convertible tops/moon roofs to protect from water damage. 
 

Valet Company is not responsible for mechanical or electrical failure, flat tires or ignition  problems.


The liability of Valet Company, if any, is specifically limited to being determined negligent in performing the agreed upon list of duties during the act of parking and retrieval of vehicles. In no event shall Valet Company be liable for loss of use, depreciation and/or consequential damages. 
 

Patron agrees to inspect vehicle before leaving the premises. Patron waives the right to recover for any alleged damage to the vehicle unless said damage is reported and itemized on Valet Company’s claim form prior to Patron leaving the premises. If Valet Company agrees to make repairs at its expense, Valet Company reserves the right to file a claim involving their insurance adjustor. 


Valet Company has no responsibility for vehicles and/or keys after closing time having been left overnight.
 

No agent or employee may enlarge the liability or assume any additional liabilities or duties on behalf of Valet Company.

By checking the box below you certify to have read the above "NOTICE OF WAIVER AND LIMITATION OF LIABILITY" and as Claimant or Team Member certify all information submitted is truthful and accurate.
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