Nova Warranty Claim Request Form

Nova Warranty Claim Request Form

Claims@NovaWarranty.com - +1 (888) 490-6672
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Protection Plan Selected*
Policy Number #*
Year*
Make*
Model*
Plan Start Mileage*
Current Mileage*
Vehicle License Plate Number*
VIN Number #*
Must be 17 digits
When did you notice this issue?*

MonthDayYear
Date
Claim Type*
Is your vehicle Leased, Owned, or Financed?*

LeasedOwnedFinanced
Is the covered vehicle used for commercial or business purposes?*

YesNo
Have you had any previous repairs done on the vehicle?*

YesNo
Have you ever modified your vehicle?*

YesNo
Is the covered vehicle insured?*

YesNo
Can the vehicle be driven without causing any further damage?*

YesNo
Was the covered vehicle towed in or drove in?*

TowedDrove
What is the address that the vehicle has been taken to?*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is the name of the repair facility that the vehicle was taken to?*
Is the repair facility that the vehicle was taken to ASE Certified?*

YesNo
Do you have a valid Drivers License?*

YesNo
What is your State License Identification Number?*
What state is your Drivers License issued out of?*
Are you the primary driver?*

YesNo
Are there any other drivers that currently use the vehicle?*

YesNo
If yes, are any of the driver that currently use the vehicle under 25 years of age?*

YesNo
Is the covered vehicle leaking any fluids?*

YesNo
In as much detail as possible, Please explain what is wrong with the covered vehicle.*
Upload any photos, files, receipts, or reports.

Cancelof
Terms of Service & Terms and Conditions*

I agree to the terms of service along with the terms and conditions.
Confirmation of Accurate Information*

I confirm that the information provided in this form is complete, true, and accurate.
Should be Empty: