Ethos Group Claims

Key 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's Full Name *

VIN *

Repair Facility Name *

Contact/Advisor Name *

Street Address *

City *

State *

Postal Code *

Contact/Advisor Email *

Used for follow-up communication and to receive claim approvals

Repair Facility Phone Number *

RO Date *

RO Number

Invoice or Work Order Number work as well

Current Mileage *

miles

Labor Guide

Hourly Labor Rate (if applicable)

Sales Tax Rate (if applicable)

Key Replacement Concern

Customer Concern*

Cause* (select cause)

Correction*

Most key contracts are limited to one key replacement per year of contract.

Enter parts needed below

Part 1

Part Description*

Part Number*

Part Quantity*

Price Per Part*

Programming Labor* (Max 0.50 hours at your labor rate)

Key coding or cut fee (if applicable)

Any additional parts, charges, or fees that are not accommodated by the form may be added to the comment section for consideration.

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.

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