File A Claim - Customer

Please complete all fields in the Customer Claim Form below.
(Items marked with an asterisk (*) are required fields.)

Customer Information

Address(Required)

Repair Facility Information

Address

Do you need to submit documents for this claim?
You may submit up to 6 documents below.

Drop files here or
Accepted file types: pdf, rtf, doc, docx, jpg, webp, png, txt, mp4, webm, Max. file size: 200 MB, Max. files: 6.