Partner Referrals | Not at Fault Accident

Partner Referral

"*" indicates required fields

1. Client Details

Referrer Name & Company*

Name

First Last

Client Phone Number*

Client Email

Address

Non-drive?

Yes

Claim Number

Vehicle Registration

Vehicle Make

Vehicle Model

Repair Start Date

Do you require any additional accessories or tools?

Canopy

Ladder Rack

Lock-Up Toolbox

Roof Rack

Tow Bar

Forward & Rear Facing Baby Seats

Booster Seats

Subject to availability.

2. Other Party Details

At Fault Personal Details

Name

Home Phone Number

Mobile Phone Number

Work Phone Number

Licence Number

At Fault Insurance Details

Insurance Company

Type of Cover

Claim Number

3. Other Vehicle Details

Other Vehicle Registration

Other Vehicle Make

Other Vehicle Model

Explain the Accident

Was there a witness?

Yes

Witness Name

Witness Phone

Did the police attend the accident?

Yes

Police Event Number

Police Station

Has the client been injured in the accident?

Yes

Does the client have a valid debit / credit card? (We need this for security for any infringements or accidents in the hire car.)

Yes

Does the client give us permission to contact the at fault party or at fault party insurance on their behalf to discuss their claim?

Yes

Other Details/Special Requests

By submitting this form I confirm that I have obtained consent from all relevant parties to disclose their information to Compass Corp and I acknowledge that Compass Corp is relying on this representation in accepting this application for a replacement vehicle.

Get in Touch

We understand how upsetting being involved in a motor vehicle accident can be. Contact Compass today and one of our friendly staff will help with any questions you may have.

1300 135 485

Email Us

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