Submit a Claim

If you desire to file a complaint or a claim with CRH AMAT New England Group, the following information is required in order for your complaint/claim to be investigated and processed.

Date of Incident*

Day of the Week*

Time of Incident*

AM / PM*

First Name*

Last Name*

Street Address*

City*

State*

Postal code*

Telephone*

Business #*

Fax #*

Email*

Vehicle Year*

Make*

Model*

Identify the specific location of the incident (city, street, road, exit, including directions of travel of all involved vehicles):*

Describe in detail the events resulting in the complaint/claim:*

Describe specific damage and/or injury:*

Who/What caused the accident?*

Identify passengers/witnesses:*

Was a CRH AMAT vehicle involved?*

Signature*

Draw a sketch of the Incident Scene below, include as much detail as possible. Attach any available pictures of damage to this form.*

Reimbursement Amount Requested:*

Please note that the receipt of this claim form does not imply that CRH AMAT accepted liability for your claim. CRH AMAT will thoroughly investigate every claim that the company receives, and issue a response to the claimant in a timely manner.