PermaPlate > Customer Service > Appearance Products Claim Form

Appearance Products Claim Form

The Online Appearance Products Claim Form is broken into 5 steps. Please Note: Any claim not comleted will not be processed. Fields marked with * are required fields.

Step 1 - Personal Contact Information

Full Name*
Street Address*
City*
State/Province*
Postal Code*
Phone Number*
Fax Number
Email Address

Step 2 - Vehicle Information

Model Year*
Vehicle Make*
Vehicle Model*
VIN Number*
Exterior Color*
Interior Color*
Current Odometer*

Step 3 - Warranty Registration Information

The prefix letter(s) and number are located at the top right corner of your Customer Registration Form.

Prefix
Number
Date Product Purchased
Dealership Name*

Step 4 - Claim Description Information

Please Note: Date(s) (MM/DD/YEAR) will be required in order to process any claim.

Date damage was noticed?*
Please provide a brief description of the damage.*
Specify the location of damage on your vehicle.*
Upload any photos of the damage (accepted file format: jpg,jpeg,gif,png. Maximum file size: 5mb)

What was the cause of damage to your vehicle?*
On what surface of your vehicle did the damage occur?*
What methods were used to attempt to remedy the damage?*
Please provide the approximate date of your last overall cleaning?*

Step 5 - Acceptance and Submission

Please read the following statements carefully, as a claim will not be processed unless initials from the claimant have been provided.

Please type your initials to indicate: I am aware that PermaPlate Company LLC, Inc. relies on the information and statements above. I hereby certify that the above statements are complete and accurate to the best of my knowledge. Any fraudulent statements will result in invalidity of warranty.

Initials of Acceptance*