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Bicycle Accidents (injuries)
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(who caused the harm?)
Bike Accidents (injury)
Describe your complaint:
(briefly describe the damages you have suffered)
Date and location of accident:
Type of bicycle involved:
Damage to bicycle, equipment and clothing (IT IS IMPORTANT NOT TO DISPOSE OF ANY EQUIPMENT OR CLOTHING INVOLVED IN THE ACCIDENT):
If another vehicle is involved in accident, make, model and year:
Identity of other persons involved in accident, as well as witnesses:
Please detail all your injuries:
Confirm email address:
Best time & way to contact you:
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