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Report Aggressive Driving Form

  1. This form is only for reporting aggressive driving incidents, which took place within the Town of Purcellville. To report aggressive driving in the Town of Purcellville, fill out as much information as possible. The license plate information will be used to locate the registered owner of the vehicle. * Indicates Required Field/Information

  2. Your Contact Information

  3. Incident Information

  4. Vehicle Information

  5. Driver Description

  6. Please be aware that information submitted to the Town of Purcellville Government is considered a Public Record under the Virginia Public Records Act, and may be subject to release by the Town in response to a request made under the Virginia Freedom of Information Act.

  7. Do not submit any unsolicited personally identifiable information including (but not limited to) your: (1) social security number; (2) driver's license number; (3) bank account numbers; (4) credit or debit card numbers; (5) personal identification numbers (PIN); (6) electronic identification codes; (7) automated or electronic signatures; or (8) passwords; or (9) any other numbers or information that can be used to access your assets, obtain identification, act as identification, or obtain goods or services.

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  9. This field is not part of the form submission.