The purpose of this form is to relate information about a vehicular accident and the subsequent property damage to the Nampa Police Department. The form has been placed online for your convenience. Upon submission, the completed form will be sent to the appropriate authorities, and a copy will be made available for you to print or save for your records.

Please fill out all required fields that are marked with an asterisk (*). To prevent spam, a CAPTCHA validation must also be completed at the bottom of the form.

Note: For simplicity, the street on which the accident occurred will be referred to as: Street 1; and, the nearest cross-street to the accident will be referred to as: Street 2.

Times and Locations

Date of Accident:	*	Day of Week:	-Select- Sunday Monday Tuesday Wednesday Thursday Friday Saturday *	Time of Accident	*
Did Accident Occur on Private Property?   -Select- Yes No *
Street on which Accident Occurred		*
Nearest Cross-Street to Accident		*
Railroad Crossing #
Interstate Interchange # or Milepost
Number of Vehicles Involved		-Select- 1 2 *
Number of People in Vehicle #1		*

Driver & Vehicle Information

Vehicle & Driver #1 Information

Please enter information about the Driver of Vehicle #1 below:

Driver's License #	*	Class:	-Select- Class A Class B Class C Class D Other N/A *	State:	*
Driver's Name	*
Driver's Phone Number	*
Street Address	*
City	*	State	*	Zip	*
Date of Birth	*	Gender	-Select- Female Male *
Seat Belt Use	-Select- Yes No *	Shoulder Belt Use    -Select- Yes No *
Insurance Company	*
Policy Number	*

Please enter information about Vehicle #1 below:

Check this box if the Driver is also the Owner of this vehicle:
Owner's Name	*
Street Address	*
City	*	State	*	Zip	*
Veh. License #	*	License State	*	License Year	*
Vehicle Year	*	Vehicle Make	*	Veh. Model	*
Body Type	-Select- 2 Door 4 Door Pickup Tractor Trailer *	V.I.N.	*	Body Color	*
Direction of Travel	-Select- North South East West *	Vehicle Traveling On    -Select- Street 1 Street 2 *
Estimated Damage to Car #1  $ *

Other Property Damage

List Other Property
Property Owner
Owner's Address
Estimated Damage
City		State		Zip

Witness Information

How many witnesses are willing to provide information to the police about this incident? Please choose:  -Select- N/A 1 2

Description of Accident

In the space below, explain in your own words exactly what transpired leading up to, during, and after the accident. Be as factual and complete as possible. You have a limit of 3,000 characters, which equates to several pages of explanation, use as much as you need to accurately describe the event.

Characters Remaining: *