FILE A CLAIM To better assist you in the claims process, please complete the following information: Who is filing the claim:*Please SelectContract HolderDealerDealer's Business Name:Dealer Contact's First Name:*Dealer Contact's Last Name:*Dealer Phone Number:Dealer Email Address: Ultimar Warranty Number:*Date of Ultimar Application:* MM slash DD slash YYYY Full Name on Warranty:*Phone Number:*Email Address:*Street Address:*Last 6 Digits of VIN:*Ultimar Selling Dealer:*Current Mileage:*Select Type of Damage:*Please SelectPaintDentAlloy wheelHeadlightCarpetUpholsteryRO Number:*Estimate:*Cause of Concern:Images of the damage are required to validate your claim. Please attached 1-6 images. Each image file should not exceed 10MB of disk size.* Drop files here or Select files Accepted file types: jpg, jpeg, gif, png, webp, Max. file size: 10 MB, Max. files: 6. Accepted file types: jpg, jpeg, gif, png.This field is hidden when viewing the formFilling SourceWebAPI Δ
