Claim Inquiry

Technician/Service person name (that's you)*

First Last

Repairing Dealership Name*

Repairing Dealer Address

Street Address Address Line 2 City State ZIP Code

Repairing Dealer Phone*

Repairing Dealer Email*

Selling Dealership Name

Aftercare contract number*

Vehicle make*

Model*

VIN*

Failure Date*

Odometer/hour meter reading*

Customer complaint*

Diagnosis of failure*

What caused the failure? What needs to be done to repair the failure?

Parts needed for repair*

Click plus sign at right to add parts

Part name	Part quantity	Parts price	Total parts price

Sales tax rate*

Labor cost*

Labor rate	Labor hours	Labor total

Claim total*

Enter claim total manually

Attach copy of Repair order or fax to 714-546-0849

Max. file size: 512 MB.

Confirmation*

By clicking the "I agree" button and submitting this claim inquiry to Aftercare, you attest to the veracity of the claims made in the above inquiry and assert that all of the information provided is true. You also affirm that: 1.) The vehicle is in your shop, torn down and available for inspection. 2.) You have done no work on the unit beyond diagnosis of the failure. 3.) You are available for further questions from Aftercare's claims department. 4.) You understand that if any of the above is not true, it may lead to the denial of the claim. 5.) Aftercare is under no obligation to reimburse your dealership for repairs made prior to receiving authorization from us.

I agree

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