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PLC:

a001t0

Agency:

city of birmingham police department

For:

incident-accident reports

Phone:

205-254-6308

Address:

1710 1st avenue north
birmingham, alabama 35203

*Required Field

Payment Information

PLEASE before making any payment contact Records Dept to make sure the report is available for purchase. 205-254-6308

*Contact Name:

Middle:

*Last:

*Contact Phone #:

(### - ### - ####)

**PLEASE allow 24hrs to process your request and email the requested report within 24hrs***

*Email Address:

Records Department does NOT Fax Reports. If you need report sent via Standard Mail List your Mailing ADDRESS in the notes section

Business Name:

*Report Type:

ANY other Reports needed call the Records Dept. at the above #.

*Name of Driver/Complaintant/Victim:

Name of Insured:

Case #:

Example: 2018-123456

Location of Occurance:

Date of Occurance:

(Month / Day / Year)

EACH REPORT IS $5.00 If you are paying for multiple reports please list all additional Case # in the notes section and ADJUST the total Amount in the Payment Amount SECTION BELOW.

Notes:

Payment Amount

*Payment Type:

Payment Amount :

Subtotal:

$0.00

Total:

$0.00

Billing Information

*First Name:

Middle Initial:

*Last Name:

*Billing Address:

*City:

*State/Province:

*Zip:

*Country:

*Phone Number:

*Credit/Debit Card:

(enter the full card number without any dashes or spaces)

*Expiration Date:

*Card Security Number:

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