NEW WARRANTY CLAIM FORM

- PRODUCT & SHIPPING WARRANTY CLAIM FORM -
Please provide details of your warranty or shipping claim to proceed with the process.
Please have original order #, order date and product images ready to upload.

Warranty plans coverage & details:

LIMITED 1 YEAR MANUFACTURER'S WARRANTY

1 & 3 YEAR RIDE HARD COVERAGE PLANS

SHIPPING PROTECTION PLAN
1. CUSTOMER INFORMATION
Full Name:

First NameLast Name
Email Address:
example@example.com
Phone #:
Please enter a valid phone number.Format: (000) 000-0000.
Address:

Street Address

Street Address Line 2

CityState

Zip Code
2. PRODUCT CLAIM INFORMATION

To avoid delays, please have original order #/date entered correctly.
Date of Claim:

MonthDayYear
Item(s) Purchased:
Please enter the name of the items purchased.
Order #:
Please enter the original order #. If unknown, enter 00000. (5 Zeros)
Order Date:
Enter the date of your order. If you don't know, enter N/A.
Purchase Method:
Purchase Protection Plan:
Product Issue:
Please select the problem with your product. You may select multiple options.
Please Describe Other Issues:
Please describe "other" issue that are not available as a selection option above.

USE THE FOLLOWING IMAGES IN THE EXPANDABLE SECTIONS BELOW TO SHOW EXACT LOCATION OF DAMAGE
Select all that apply to your claim:
- Front Windshield Anatomy
- Rear Windshield Anatomy | 1 Piece | 2 Piece | 3 Piece
- Vault Anatomy | Driver Side Front | Passenger Side Front | Driver Side Rear | Passenger Side Rear
The images below are general depictions of most products. Your specific product may not look exactly like the schematics depicted. Skip sections that do not apply to your claim, otherwise, use the following options to provide as much information as possible. Please contact us if you have questions in regards to making sure your claim is submitted properly as to avoid any delays.
- FRONT WINDSHIELD ANATOMY - Select all that apply based on the image above.
- 1 PIECE REAR WINDSHIELD ANATOMY
- 2 PIECE REAR WINDSHIELD ANATOMY
- 4 PIECE REAR WINDSHIELD ANATOMY
- DRIVER SIDE VAULT ANATOMY - Select all that apply based on the image above.
- PASSENGER SIDE VAULT ANATOMY - Select all that apply based on the image above.
- DRIVER SIDE REAR (4 DOOR) ANATOMY - Select all that apply based on the image above.
- PASSENGER SIDE REAR (4 DOOR) ANATOMY - Select all that apply based on the image above.

Product Status:
Original Product Packaging:
Detailed Description of Damage, Defect or Issue:
Please enter as many details as you can. The more information we have the better. Thank you.
Additional Information or Comments Relevant to the Claim:
Upload a Minimum of 3 Photos:

TIP: The more images the better. But at a minimum, at least 1 photo close-up of issue and 2 or more from a distance so we are better able to understand the issue. You may also upload video. File types allowed: pdf, zip, wma, mpg, flv, avi, jpg, jpeg, png, gif, mp4, mov, wmv, mkv, webm, 3gpp, 3gpp2, mpeg
Cancelof
LIMITED 1 YEAR MANUFACTURER'S WARRANTY

1 & 3 YEAR RIDE HARD COVERAGE PLANS

SHIPPING PROTECTION PLAN
3. SUBMIT

You will receive an email with your claim information after you submit. If you do not receive it, please check your junk/spam folder from sender noreply@jotform.com
Should be Empty:

- PRODUCT & SHIPPING WARRANTY CLAIM FORM -