Vehicle Accident Damage Release
This Vehicle Accident Damage Release ("Release") is made and entered into on this ___ day of __________, 20___, by and between:
Releasee: ______________________________
Address: ______________________________
Phone: ______________________________
Releasor: ______________________________
Address: ______________________________
Phone: ______________________________
Both parties acknowledge their respective rights under the laws of the state of __________.
In consideration of the payment of $__________, the Releasor hereby releases, acquits, and discharges the Releasee from any and all claims, demands, actions, or causes of action arising out of or related to the accident that occurred on ___ day of __________, 20___, at the following location: ____________________________.
This Release includes, but is not limited to, the following:
- Property damage
- Pain and suffering
- Medical expenses
- Loss of income
The undersigned acknowledges that they have read this Release and fully understand its terms. This Release contains the entire agreement between the parties concerning this subject matter, and no oral statements or prior written material not specifically incorporated herein shall be of any force and effect.
The parties agree that this Release shall be binding upon them and their respective heirs, executors, administrators, and assigns.
By signing below, the Releasor affirms that they have the authority to execute this Release and that all the information provided is true and accurate to the best of their knowledge.
Releasor Signature: ______________________________
Date: ______________________________
Releasee Signature: ______________________________
Date: ______________________________