Submitting Claim For: *

Invoice Number *

vehicle of Vehicle

Customer Name *

Customer Phone *

Customer Email *

Name of Repair Shop *

Repair Shop Phone *

Repair Shop Contact

VIN # of Vehicle *

Invoice from Shop Installation *

Is the Vehicle Stock? *

How many miles since purchase? *

Pictures of the Heat Tabs

Drag & Drop Files, Choose Files to Upload

Pictures of the Stock Number/Purchase Order *

Drag & Drop Files, Choose Files to Upload

Pictures of the Vehicle Itself *

Drag & Drop Files, Choose Files to Upload

Invoice for Fluids/Filters *

Drag & Drop Files, Choose Files to Upload

What happened when the vehicle started having issues? *

Symptoms Described by Shop *

Please explain any diagnosing that the shop has performed. *

Please list any scanner codes. *

Your Items