MAKE 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, Max. file size: 10 MB, Max. files: 6. Accepted file types: jpg, jpeg, gif, png. Δ
