Premier Valet Service

Valet Incident Report

🛑 REPORT AN INCIDENT PROMPTLY 🛑

We’re committed to safety, transparency, and accountability at every step.
If an incident has occurred during valet service, please fill out the report form below completely.
For immediate concerns, contact us at (855) 432-2634.

Date of Loss

Time of Incident

Name of Filer

Occurrence address:

Street Address

Street Address Line 2

City

State

ZIP Code

Manager on Duty

Valet-Parked Vehicle

Valet-Retrieved Vehicle

Phone Number

Driver’s License Number

Police Report Number

Signature

Incident Information

VIN Number

Vehicle (Year, Make, Model)

Vehicle Color

Other Vehicle Involved

Describe Incident & Damage

Photos of Damage

Weather Conditions

Vehicle Owner Information

Vehicle Owner Full Name

Owner’s Home Address:

Street Address

Street Address Line 2

City

State

ZIP Code

Owner’s Phone Number

Owner’s Email

Signature

locations

138 Lake Dr, East Patchogue, NY 11772, United States

email

info@permiervalet.co

COntact

(855) 432-2634