Responding Police Department (e.g. Illinois State Police, Naperville Police Department, Will County Sheriff) *
Your answer
Did YOU receive a traffic ticket? *
Did the OTHER DRIVER receive a traffic ticket? *
Were you injured in the collision? *
Location of the accident (e.g. Plainfield-Naperville Road at Boughton or Mile 246 on I-55 North) *
Your answer
Report Number (can be found on Driver Information Exchange or at the top right corner of the Motorist Report) *
Your answer
You were a: *
Do you already have an attorney? *
What is your home address? *
Your answer
What is your phone number? *
Your answer
What is your Driver's License number? *
Your answer
What state issued your driver's license? *
Your answer
I hereby authorize Marker & Crannell to use the above information to obtain a police report regarding my car accident. My private information will only be used for this purpose. I understand that no attorney-client relationship is created by filling out this form and no such attorney-client relationship has been formed until an attorney-client agreement has been executed by you and Marker & Crannell. Marker & Crannell warrants that it will not use the information provided herein or from the police report for any purpose other than to provide the police report to you and to evaluate the potential case. *