Paragon Subrogation Services, Inc.
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(888) 329-3332
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Insured Statement Form

    Your Information

    Description of Vehicle:

    Other Party's Information

    Description of Vehicle:

    Details of Accident (time, date, location):

    Please attach any evidence that you would like to provide here (photos, diagrams, written statements, police reports, and etc.):
    Max file size: 20MB
    Upload any evidence that you believe will help our case.

    Signature of Insured Driver:

Submit
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