Ethos Group Claims

Claim Request Form

Fields marked '*' are required. Providing detailed claim information and uploading the Repair Order (RO) enables us to more efficiently review and process payment for this claim. We pay up to MSRP on part price and determine labor by referencing any national, publicized labor guide.

Customer's Full Name *

VIN *

Facility Name *

Contact Name *

Street Address *

City *

State *

Postal Code *

Email *

Used for follow-up communication and to receive claim approvals

Phone Number *

Labor Guide

Hourly Labor Rate (if applicable)

RO Date *

RO Number

Current Mileage *

miles

Request Type *(select all that apply)

Maintenance

Paintless dent repair

Windshield repair/replacement

Stain Removal

Fabric Repair

Tire/wheel repair or replace

Paint repair

Vehicle Repair

Other

Concern 1

Customer Concern *

Cause *

Correction *

Part #/Description*

Part Price *

Part Quantity *

Diagnosis Time (if applicable)

Labor (Hours or $ Amount) *

Any additional parts, charges, or fees that are not accommodated by the form may be added to the comment section for consideration. For maintenance claims, please utilize menu pricing. A detailed breakdown of parts and labor is not required.

Towing Amount (if applicable)

Covered up to $100

Rental Days (if applicable)

days

Covered up to $35/day

For all claims, the Repair Order is required for payment.
For non-mechanical repairs, documentation of proof of damage is required.
For towing and car rental services, sublet form is required.
If this claim has a concern with more than 6 parts, upload a photo of the part estimate

Drag and drop or Browse
Only jpeg, png, and pdf formats
Up to 5 files at 4 MB per file