Claims Procedure Claim Information form

New Claim

Owner/Customer Name

Vehicle

Repair Company

Resolution Info

Costs

$
$
%
Eg. 1.00% = 1%, 100.00 = 100%

Documents


Submit the following information:
  1. All service repair orders indicating compliance with terms and conditions of the BG Protection Plan, including BG part numbers, retail prices and labor charges.
  2. Bill of sale, if the vehicle is pre-owned and the RO showing PVP kit installation.
  3. The lease agreement, if the vehicle is leased.
  4. The estimate for repairs, including part numbers, prices and labor hours. If the repair in question has not been fully diagnosed and/or torn down, the Repair Facility must get the customer’s authorization to do so and email or fax(1-316-265-6047) CCM when a complete diagnosis is available. (Charges for diagnostic procedures and teardown costs are not covered unless they are an integral part of the repair.)

If you have problems uploading you may fax the required documents to 1-316-265-6047