Interior 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 *

Key

Key Fob

Location of Damage (Choose all options that apply)

Puncture / Burn

Rip / Tear

Stains (Choose all options that apply)

Touch Screen

Type of Material

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 to upload

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

Drag and drop files here to upload

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