SLEEPYPOD: Crash Replacement Program Form

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Your Full Name:* This field is required.
First Name
Last Name
2
Email:* This field is required.
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3
Phone Number:
Area Code
Phone Number
4
Your Shipping Address:* This field is required.If eligible, your replacement will be shipped to this address.
Street Address
Street Address Line 2
City
State
Zip Code
United States
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5
Proof of Original Purchase:* This field is required.Please upload a copy of your purchase receipt or order confirmation email.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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6
Date/Time Incident Occurred:* This field is required.Specify the date and approximate time of the incident, if known.
Date
Month
Day
Year
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2
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8
9
10
11
12
Hour
00
10
20
30
40
50
Minutes
PM
AM
PM
7
Accident Details:* This field is required.Please describe what happened (speed, impact, injuries, vehicle damage, etc).
Please share as many details as possible.
8
Photos of Damaged Vehicle:* This field is required.
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Max. file size: 10.6MB
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9
Copy of Police Report/Insurance Claim:* This field is required.For your privacy, you’re welcome to hide any personal details such as your VIN or license plate number before sending your report.
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Select files to upload
Max. file size: 10.6MB
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10
Pet Details:* This field is required.Please share your pet's name, age, weight, and where your pet was sitting at the time of the accident.
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Photos of Your Pet:
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Select files to upload
Max. file size: 10.6MB
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Attestation:* This field is required.I certify that the information provided in this form is true and correct and that by submitting the photos and information to Sleepypod, I am giving all rights to Sleepypod to later use for research, development, and promotional purposes.
Clear
13
Center For Pet Safety:
I would like to share my accident information with Center for Pet Safety. Center for Pet Safety is a registered 501(c)3 research and advocacy organization dedicated to companion animal and consumer safety. Find more information about Center for Pet Safety at CenterForPetSafety.org.
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