Exterior Claim

First Name *

Last Name *

Email Address *

Confirm Email Address *

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Country *

Home Phone *

Work Phone

Are you a Repair Shop?

Purchasing Dealership Name

Warranty Number *

Vehicle Year *

Vehicle Make *

Vehicle Model *

VIN (full or last 8 characters)*

Vehicle Color *

Vehicle Mileage / Engine Hours *

Date Damage Noticed *

Location of Damage (Choose all options that apply)

Type of Damage (Choose all options that apply)

Additional Comments

Please note that we only allow up to 20MB per attached file. There is a 200MB limit across all attached files.

Drag and drop files here

For Warranty/Estimate file(s), we accept the following file types: .pdf, .jpeg, .jpg, .png, .heic

Drag and drop files here

For Picture(s) of Damage, we accept the following file types: .jpeg, .jpg, .png, .heic

I certify the information on this form is complete and accurate