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Paint or Paintless Dent Repair 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. Filing this form does not imply that repairs are covered! Once the form is submitted we will review and respond back with either approval or request for additional information.
Customer Information
Facility Information
Used for follow-up communication and to receive claim approvals
Repair Information
Invoice or Work Order Number work as well
miles
    Paint Correction (buffing - no paint work)
    Requires picture of damage and repair estimate before repairs will be approved. You can upload at the bottom of this form.
    Paintless Dent Repair (no conventional body work, dent less than 2 inch in diameter)
    If you have additional dents that are a different price per dent enter those below.
    Paintless dent repair claims require pictures of dents and repair estimate before repairs will be approved. You can upload at the bottom of this form.
    Paint Damage (requiring paint work)
    Requires picture of damage and repair estimate before repairs will be approved. You can upload at the bottom of this form.
    Comments
    File Upload
    • For all claims, the Completed Repair Order Signed by Contract Holder is required for payment.
    • For non-mechanical repairs, documentation of proof of damage is required.
    Drag and drop or Browse
    Only jpeg, png, and pdf formats
    Up to 5 files at 4 MB per file