Forms

SUBMIT A CLAIM ONLINE

Contract Holder Information

First Name

Last Name

Home Phone

Work Phone

Contact Information: (*Required Fields)

* Contact Person

* First Name

* Last Name

* Home Phone

* Work Phone

* Covered Property Address

* City

* State

* Zipcode

* Please check the services you are requesting
NOTE: Not all items below may be covered by your contract. please check your contract before you place your claim.

*Please describe the malfunction with as much specific detail as possible

(including make, model, and capacity):

Once your coverage has been confirmed, a contractor will call you within 4 business hours to schedule a mutually convenient appointment time. You may receive a call from a local representative for quality assurance prior to the service contractor. Please refer to your contract for specific detail of coverage and limitations. Service calls are subject to a per trade service fee. Please see your contract for service fee amount.