Warranty Claim Form Name * I am making a claim on the following contract number regarding the Enviro Guard Warranty. The information I am providing is true and correct. First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Enviro Warranty Contract * What type of vehicle? * Date vehicle was purchased * MM DD YYYY Name of dealer vehicle was purchased from * City and state where vehicle was purchased * Has this vehicle had reasonable care? * What is the stain? * Date stain occured * MM DD YYYY How many stains? * List all mandatory dates of renewal on exterior for the Enviro Guard 2000: * List all mandatory dates of renewal on the Vinyl Leather Enviro Guard: * Today's Date * MM DD YYYY Agreement * I state that the above information is correct and I have read all warranty exclusions on my contract. Note: • Please explain fully and in detail to each question on this claim form. • If you have any questions regarding dates please refer to your contract. •we will need a copy of your original contract. •We will need photographs of the stains to complete the claim. Photo * Please upload a Photo of the Stain Upload Thank you! Having an Issue? Download a Printable Form.
