APPEARANCE CLAIM FORM

APPEARANCE CLAIM FORM
🚨 Please See the Link Below to Access Our New & Improved Claims Website!🚨

"NEW AND IMPROVED CLAIMS SITE LINK HERE"

Once you submit your first claim, you’ll have the option to create a personalized Claims Dashboard that provides real-time updates on your claim status.

Questions? We’re here to help — call us at 866-660-7003.
Repair shop name*

First NameLast Name
What type of claim

WindshieldKeyPaintPDR (Paint Dent Repair)WheelTireInterior/Exterior
Advisor Name*

First NameLast Name
Repair shop address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Repair shop email*
Customer Name*

First NameLast Name
VIN (Vehicle Identification Number) *
Are you the customer or repair facility*

CustomerRepair Shop
Mileage*
Estimated Completion Date*

MonthDayYear
Date
Estimated completion time if its being completed day of submission.

Hour Minutes

AM/PM Option
Date of incident*

MonthDayYear
Date
Repair order number*
Phone Number*
Please enter a valid phone number.
Date*

MonthDayYear
Date
Total amount requested*
What type of damage?*
Description of damage*
Cause of damage?*
UPLOAD ESTIMATE HERE*

Cancelof
UPLOAD PHOTOS HERE*

Cancelof
Should be Empty: