Vehicle Accident

1. Page 1

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1. We understand you were involved in a car crash in the last 5 years, is this correct? *

Yes
No

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2. How was your car damaged? *

Front Impact
Rear impact
Side Impact
Other (please specify):

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3. Did the other driver deny being at fault? *

Yes
No
Not Applicable

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4. Do you feel the accident was the result of a ‘crash for cash’ scam in which the accident was planned by the other driver? *

Yes
No
Not Applicable

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5. Approximate Annual Mileage at time of accident? *

Less than 10,000
10,000 to 19,999
20,000 to 29,999
30,000 to 39,999
40,000 to 49,999
50,000 to 59,999
60,000 to 69,999
70,000 to 79,999
80,000 to 89,999
90,000 to 99,999
100,000 to 149,999
150,000 or more

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6. Did you record the accident using a car camera or dash cam? *

Yes
No

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7. Do you feel a car camera or dash cam would have been helpful in anyway? *

Yes
No

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8. Do you plan to purchase a car camera or dash cam? *

Yes
No

9. Name and Address to send voucher

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10. Would you like to receive future surveys and notifications of product launches relating to this survey? No third parties will receive any information you provide. *

Yes
No

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