Claims

ALL CLAIMS MUST BE PRE-AUTHORIZED PRIOR TO COMPLETING ANY TIRE REPAIR OR REPLACEMENT

Please verify customer registration before submitting claim

Member / Tag Number

First Name (required)

Last Name (required)

VIN (required)

Mileage (No commas; required)

Claim Type (required)

Tire Description (required)

Tread Depth (required)

Tire Brand (required)

Tire Model (required)

Tire Size (required)

Dealer Name (required)

Dealer Contact Name (required)

Dealer Contact Phone (required)

Dealer Contact Email (required)

Repair Order Number (required)

Repair Order File (required)

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Parts Cost (required)

Labor Cost (required)

Sales Tax (required)

Damage Description (Please be as detailed as possible)

Damage Photo (required)

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Full Tread Photo (required)

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Full Sidewall Photo (required)

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VIN Photo

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Additional Photo #1

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Additional Photo #2

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Additional Photo #3

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